In order to quickly and accurately respond to the change in the level of illness of the population of the state, it is necessary to read the structure of pathologies, in order to introduce corrections in the activity of health care organizations.

For which All-World Organization for the Protection of Health, the international classification structure of sickness was found. In medical stakes, they are called MKL. Naprikintsi 2000 r. By law of the Russian Federation, the classification of illness was adopted on the 10th revision, as it will continue to function until 2017-2018.

Be it as a diagnosis of an ailment, I can clinically classify, based on symptoms. Vaughn can name the illness, the variant of the overrun, the characteristic of severity and, if necessary, the introduction is more complicated. Immunodeficiency is also on the list of these states.

Clinical classification of VIL-infection according to WHO is necessary for the establishment of the primary diagnosis in the first 72 years after joining the medical mortgage and winning for recognition of the treatment, assessment of the severity of the main disease and suputny, calculation of the risk of development mortal complication is the punishment of a distant plan for the sick.

Also, there is a statistical classification of VIL (2001 revision) and other ciphers, on the basis of which they assess the current situation of infection in the region and the state in a flash.

For pathologies accompanied by immunodeficiency, the same rules for coding and making a diagnosis apply, as for other ailments. The classification of VIL is considered to be in manifestation of secondary ailments, as in the skin stage of infection. The correct coding of immunodeficiency and the criteria for assessing the scale of the epidemic and allow for the legislator's level to live in the area of ​​the expansion of the VIL. The class, which occupies all the widest forms of manifestation of infection, is called "Sickness, caused by a virus to the human immunodeficiency." According to the ICD, VIL-іnfektsіya depends on a number of codes, sorted sequentially - V.20, V.21, V.22, V.23, V.24. Usі cody ВІL in vіdpovіdat zahvoryuvannya, vіdobrazhayut mechnіzn іnfektsієyu іnfektsієyu podbachayut poddachiyut prognosis for people.

Clinical classification of HIV infection

Based on this, doctors-practitioners subdivide the pathology into 4 last stages:

1. Gostra VIL-infection:

• hostile retroviral syndrome.

2. Clinical stage 1:

• asymptomatic (asymptomatic);
• persistent generalized lymphadenopathy (permanent improvement of all groups of lymph nodes).

3.2 clinical stage of HIV infection with MCL 10:

• seborrheic dermatitis (injury to the skin and sebaceous deposits);
• angular cheilitis (cracks in the folds of the lips, so called zaїdi);
• recurrent attacks of an empty mouth (two or more episodes of a stretch of 6 months, wounds that are constantly appearing on clear and mucous membranes);
• operating lichen (herpes, which manifests itself as a stretch of nerve endings);
• recurrent infections of dyhal passages (two or more episodes lasting 6 months);
• fungal infection of the nails (important on the legs);
• papular itching dermatitis (one by one, the whisker is widened along the entire surface of the body, as if itching).

4. Clinical stage 3:

• hairy leukoplakia of an empty mouth (mainly affected by the bichni parts of the tongue);
• unexplained chronic diarrhea for more than 1 month (may appear as rare malformations 5-6 times a day, as well as porridge-like 1-2 times for doba, mainly after eating);
• recurrent candidiasis of the oral cavity (two or more episodes of stretching);
• an important bacterial infection of any organs, which often leaked and did not fit the standard treatment;
• gostriya virazkovo-necrotic stomatitis, gingivitis or periodontitis (often ill do not respond to standard treatment, antibiotic therapy and treatment of folk remedies);
• myositis, osteomyelitis (inflammation of m'yaziv and okistya, which is accompanied by strong sickness and impaired function of the organ);
• cystitis (inflammation of sich mihur with blood, bacteria and mucus).

When one of the overexposures is detected, more pathologies are shown at the first stage of VIL-infection according to ICD 10. This diagnosis is entered in the statistical coupon with a sign that confirms the code of VIL-infection.

Change coding VIL 10 revision in 2001

The classification of VIL-infections by codes in the MCL with WHO allows you to quickly and reliably assess the spread of the virus among the population of any country. In order to reduce the rate of infection among the population, it is necessary to develop special methods of prevention, to carry out roz'yasnyuvaln_ rozmov and among the group of people and systematically intimidate these people.

In order to determine which ball of the population is the most slender before infection, the system of ciphers is broken up, which characterizes the interests and way of life of a person. For help VIL code ICD 10, you can determine the way of infection. The stench is indicated on the forms for the hour of exacerbation of the presence of a retrovirus. At different times of the number of factors on the coupon, all the necessary ciphers can be recognized.

Codi to the contingent on VIL

Codes of VIL-іnfіkovanyh, scho signify possible routes of infection, are always indicated. Tse allows you to identify the middle of the infection and the recognition of the nose, as if you were infected when in contact with the disease.

The widest codes VIL for MKL:

• 100 - the bulk of Russia and the people who are equal to them.
• 102 - drug addicts and individuals who live other psychotic speeches.
• 105 - a person who is being tested, may experience a lack of handsless state contacts.
• 106 - foreigners.
• ВІL code 113 - individuals that may be symptomatic of immunodeficiency.
• ВІL code 118 - tests were infected with a retrovirus in the scientific ways, where the ciphers were already broken. Like a person locking up all possible ciphers, the very meaning is shown.

The beginning of the classification of VIL according to ICD 10, as well as the splitting of the ciphers of the contingent contingents, the state is splitting and passing bills, as if they will protect the deadly pandemics that are developing. The WHO plans to reduce the incidence of illness at VIL in 10 years by a practical 20-30%. For such plans, a lot of money has been invested. Postiyne dotrimannya prophylactic visits to allow zdiyasnit namіri VOZ, in some skin infestations the bag of our planet.

Zgidno with addendum No. 3 to the order of the department of health protection and social protection of the population of the Bilgorod region on September 11, 2009. No. 1 "On optimizing the population of the Bilgorod region for VIL-infection", mandate No. 1317 dated 26.05.15 p. the main codes for the hour of obstezhennia for children are the following:

1. Code 104 - ailments from illnesses that are transmitted by a state path, when a diagnosis is made or symptoms of IPSS are evident and after 6 months .

2. Code 109- women in the 1st and 3rd trimesters of pregnancy, medical abortions .

3. Code 111 - individuals who are called up for military service - 1 time.

4. CODE 113 - obstezhennya for clinical indications, incl. sickness with pidozroyu chi confirmed by diagnosis:

mononucleosis (after 3 months after the cob of illness);

Pneumocystosis (pneumonia);

Toxoplasmosis (central nervous system);

Candidiasis of the stravokhod, bronchi, trachea and legen;

Deep mycoses;

atypical mycobacterioses;

· Progressive bagato-seredkovo leukoencephalopathy;

· anemia different genesis

and other SNID-associated infections.

Diseases on clinical indications:

· Long-term ailments, yakі do not include the diagnosis of "VIL-infection";

· May zbіlshennya limfovuzlіv two or more groups over 1 month;

· With diarrhea, which lasts more than a month;

· With an obscure vtratoyu weight of the body by 10 and more vіdsotkіv;

· from protracted and recurrent pneumonias or pneumonias that do not require primary therapy;

· with pіdhostrim encephalitis and bewilderment in previously healthy osіb;

· Hairy leukoplakієyu movi;

· Recurrent pyoderma;

· Zhіnki z hr. Burning diseases of the female reproductive system of unclear etiology

5. Code 114 - viral hepatitis B, C, presence of markers (When diagnosed after 6 months).

6. Code 118- second contingent (for pr. No. 1317):

Code 118c - individuals for social indications (sickness for alcoholism, homeless people);

Code 118m-medical practitioners in hospitals (departments) of a surgical profile;

Code 118o - biological fathers of future children;

Code 118x-individuals from 18 to 55 years, which should go for invasive insertion.

7. Code 124 - children, yakі were born in VIL-infected mothers (when born, at 12 and 18 months).

8. Code 128 - arranged voluntarily with the initiative of the patient.

9. Code 200- children who arrived, for the removal of the community, certificates for living (Paid).

10. Code 200/y - hulks, like timchasov, deprived Ukraine - after arrival

Directly on the obstruction, indicate the material code and the reason for obstezhennaya (diagnosis).

You can consult with specialists in the office of anonymous ventilation VIL - іnfektsії tel. 42-85-86.

Note: Compliant with the Federal Law "On the prevention of expansion in the Russian Federation of illness, which is caused by the human immunodeficiency virus (VIL-infection)", the primus congestion in the VIL is vaccinated.

Likar - epidemiologist M. V. Nelyapina.

State Budgetary Lighting of the Middle Professional Lighting
"Kurgan Basic Medical College"

INITIAL AND METHODOLOGICAL POSIBNIK

VIL INFECTION

for independent training to qualifying certification test
for the withdrawal of a specialist certificate
graduates of specialties:

"Likuvalna on the right",
"Medical-prophylactic on the right",
"Sister on the right",
"Obstetrician on the right",
"Laboratory diagnostics"
"Pharmacy"

Kurgan 2013

1. VIL-infection - ailment, which is called by a retrovirus, which attacks cells of the immune, nervous and other systems and organs of a person, s trivalim chronic progressive overrun, which ends with the development of the stage of SNID and accompanying yogo opportunistic diseases

2. An epidemiological observation of illnesses, which are called by the virus of human immunodeficiency, is conducted in the world from the cob of the 80s.
Features of HIV infection

• trivaliy asymptomatic (in the middle 8-10 years) period of VIL-infection to the development of SNID,
• foldability of the manifestation of infection in the most striking groups of the population, small groups of groups are important for the health care system,
• the inevitability of illness, the inevitability of a deadly result,
• stigmatization and discrimination of HIV-infected suspіlstvo,
• medical-social-political implications and rethinking the development of the epidemic.

3. The legacy of the epidemic

Socio-biological
Change in the number of people
Pain and death of part of the population
Psychological stress
Change in possible population
Change in the average life
Social and economic
Change in the practical part of the population
An increase in the impractical part of the population
Decrease in virobnitstva
Degradation of other species of virobnitstva
Budget imbalance
Socio-political
Change of legislation
Destruction of geopolitical jealousy

4. BASIC CONCEPTS

• VIL- human immunodeficiency virus

• SNID– full-bodied immunodeficiency syndrome
• VIL infection10 - 15 years
• SNID1 - 1.5 rocks
• Dzherelo VIL-infections- people

5. Peculiarities of the clinical course of VIL-infection

• Inevitable fatal result.

6. Trivality of life for those who are ill for VIL-infection

• Minimum - 3 months.
• The maximum is over 20 years.
• As soon as you are infected, then VIL-infection progresses more rapidly.

7. Peculiarities of HIV infection in children

• Shvidky progress of illness in children, yak became infected intrauterine or in the first roci of life.
• In children who have become infected with the older one, the disease progresses more, lower in adults.
• Children are more often, lower grown up, there are important bacterial infections.

8. Peculiarities of HIV infection in children

• Older, lower in adults, Kaposi's sarcoma is indicated.
• Most often, lower in adults, there is anemia and/or thrombocytopenia.

9. INFECTIOUSLY UNSAFE BIOLOGICAL RIDINS:

• KROV - 10 yew-70 yew іnfik. doses per 1 ml
• SEMEN - 70-100 infectious doses per 1 ml
• VAGINAL SECRET - 10-50 infectious doses per 1 ml
• BREAST MILK, SALIVA, SLICE - 1 infectious dose in 100 ml

For infection it is necessary -100-1000 i.

10. VIL-INFECTION TRANSMISSION WAYS

• Natural
• 1. Article - homo, bi-, heterosexual contacts
• 2. Vertical - in the form of the child's mother, in the form of the child's mother.
• piece
• 3. Parenteral - through the blood and other biological sources

Mechanism of infection - hemocontact
With the progression of the disease, the evolution of VIL from a less virulent to a virulent variant is observed.
ВІL unstoppable in the old middle:
Inactivated at 56 degrees after 30 minutes.
ВІL after a quick hyna at boiling, after 1-3 minutes, as well as a change in the ph of the middle, as well as under the infusion of disinfectant speeches, which sound like vicorist in the LPZ.
You can save yourself from the dried-up camp from the drops of blood and sperm. Kindly take care of minus temperatures.

11. Klitini - targets of VIL

• Dendritic cells
• Monocytes/macrophages
• T-lymphocytes
• Megakaryocytes
• Clitini thymus
• eosinophils
• Clitini-intestine
• CNS cells: neurons, microglia, astrocytes

12. Change of contingents, as if they apply obov'yazykovo obtezhenniyu on VIL-infection

• donors of blood, plasma, sperm and other biological mothers, tissues and organs in case of skin sampling of donor material, as well as vagina during the sampling of abortive and placental blood for the development of immunobiological preparations (code 108)
• doctors, middle and young medical personnel of the centers for prevention and control of SNID, establishments of health protection, specialization of foundations for the protection of health, scientifically advanced and other establishments of organizations, the work of such organizations is connected with degrees, diagnostics, exuberance , services, conducted courts and other work with persons infected with VIL, or the work is tied with material to avenge the virus on human immunodeficiency (code 115)
• when entering the territory of the Russian Federation of foreign citizens for more than 3 months, I will allow a temporary residence permit, or a certificate of residence, or a medical examination of the VIL. This follow-up is carried out on a paid basis and is valid 1 day (200 code)

13. Change of contingents, as a kind of voluntary exposure to VIL-infection

• patients who are suffering from intoxicating drugs, ailments for imitation or confirming the diagnosis of "drug addiction" are obstezhuyutsya in likuvalno-prophylactic mortgages in the case of medical assistance to be-like fahivtsya and nadal in case of skin tympanic, like drug addiction and in three, but not more often 1 time per quarter ( 102 code)
• individuals with risky sexual behavior (code 104)
• ailments for illness, which are transmitted by a statute, are obstezhuyutsya when they are detected and when taken from a dispensary form (code 104)
• vagitnі, scho wine vagitnіst, obstezhuyutsya dvіchі: when placed on the appearance of that in the III trimester (code 109)
• dobrovіlne, including anonymously, exacerbation for VIL-infection is carried out on the passing of an individual, which looks around, at the time of looking at an incomplete century, up to 14 years for passing through, or for the sake of a legal representative (code 118)

14. Change of contingents
at VIL for epidemiological indications
(120 code)

• individuals, yakі small narcotic contacts with IVL-infection during intravenous injection of drugs, are obstructed by the presence of pressure and pressure after 3, 6 and 12 months. after attaching to the contact. If the contact is not interrupted, the skin is closed for 3 minutes;
• individuals, as small state contacts with ailments for VIL-infection, are obstructed in case of manifested and nadal protracted rock 3 times (after 3, 6, 12 months after the state contact is made), permanent state partners are obscured for a long time 1 time for 6 mis;
• individuals, although there are few medical contacts with VIL-infections, which do not include the possibility of a parenteral route of infection in the licuvial-prophylactic settings, medical practitioners with a risk of occupational infection as a result of an "emergency situation" when receiving medical assistance B ІL-іnfikovanim, obstezhuyutsya when exposed and nadalі 3 protyazh roku (3 6, 12 months)
• recipients of blood, sperm, organs and tissues of VIL-infected patients are obstructed in case of nadal and nadal manifestations 3 times a day (after 3, 6, 12 months) until a residual diagnosis is made

Dobrovilne obstezhennya 118 code - інші

15. Clinical indications for obstezhennia
for HIV infection (code 113, children and adults)

1. Overhead display:

• • Hot more than 1 minute;
  • can improve lymph nodes of 2 and more groups over 1 month;
  • with an unreasonable waste of weight of the body by 10 and more vіdsotkіv;
  • from protracted and recurrent pneumonia (more than 2 times per rec),
  • bacterial infections, sepsis,
  • pyoderma;
  • with hairy leukoplakia of the tongue;
  • women from hr. adnexitis unclear etіol.

• sarcoma of Kaposi;
• Lymphoma of the brain;
• T-cell leukemia
• Pulmonary and post-legal tuberculosis;
• parenteral hepatitis;
• Pneumocystosis, toxaplasmosis, cryptococcosis, cryptosporidiosis, isosporosis, histoplasmosis, strongidosis; Candidiasis of the stravokhod, bronchi, trachea or lungs;
• Anemia, leukopenia, lymphopenia of unknown origin;
• Invasive uterine carcinoma
• Serous protracted meningoencephalitis of unclear etiology

16. Trivality of overcoming VIL-infection

• 90% - 7-10 years
• Mensh 10% - over 10-15 years
• Less than 5% - less than 3 years

• The optimal start of ARV therapy is CI less than 350 cells/mm3

17. Russian classification of HIV infection (2002)

1. Stage of incubation
2. Stage of first development
A. Asymptomatic circoconversion.
B. Gostra IV-infection without secondary illnesses.
V. Gostra infection due to secondary illnesses.
3. Subclinical stage
Stage of secondary illnesses
1) 4A - Vaga intrusion< 10%; грибковые, вирусные, бактериальные поражения кожи и слизистых; опоясывающий лишай; повторные фарингиты, синуситы.
2) 4B - Carriage loss > 10%; unrecognized diarrhea or fever for more than one month; hairy leukoplakia; tuberculosis; repeated attacks of viral, bacterial, fungal, protozoan damage to internal organs; repeated or disseminated operative lichen; Kaposi's sarcoma was localized.
Phases: progression, remissions.

Phases: progression, remissions.

• 5. Terminal stage.
• Progression:
  • against the background of the presence of antiretroviral therapy;
  • on aphids antiretroviral therapy.
• Remission:
  • spontaneous;
  • after previous antiretroviral therapy;
  • on the background of antiretroviral therapy

18. Potentially unsafe home:

• shelter
• lymph
• sperm
• vaginal secret
• exudate (ascitic, cerebro-spinal, pleural, synovial, pericardial, amniotic

all biological mothers to avenge the visible house of blood

19. The steadfastness of VIL at the old center

ВІL - weak in the old middle.
- When boiling gin after 1 min.
- Heating up to 56 C - after 30 min.
- Obrobtsі 70% alcohol after 3-5 minutes.
- infusion of disinfectants (chloramine, chlorine vapno, water peroxide) - 3-5 min.
For VIL harmful sonyachne and piece UV-viprominuvannya, all kinds of ionizing viprominuvannya
When the plasma is dried at 250C, after 7 deb.
In a rare medium at a temperature of 23-270C, the activity lasts 15 days
Frozen blood and plasma save rocks
Frozen sperm saves a few months

20. VIL is not transferable

• with hand-to-hand or clips;
• with a kiss / through a sling;
• through pet chi tears;
• when coughing and wheezing;
• when vikoristanni zahalnogo utensils;
• through bedtime whiteness;
• at the sum of coristuvanni bathroom, toilet, at the pool;
• through the creature ta bite coma

21. Ways to spread the virus

There are two main ways of transmission of infection:
NATURAL
Articles - homo-, bi-, heterosexual contacts.
Vertical - from the mother to the child, from the child to the mother
piece
Parenteral - through the blood
Transmission mechanism -
HEMOCONTACT (blood contact,
hemopercutaneous)

22. Change of contingents, as if they apply obov'yazykovo obtezhennyu on VIL-infection

• donors of biological tissues, tissues and organs in case of skin sampling of donor material (code 108)
• doctors, middle and junior medical staff (code 115)
• when foreign citizens enter the territory of the Russian Federation for more than 3 months (code 200)
• Individuals, yakі enter the service for a contract for military service (code 118)

23. Transfer of contingents, as if they were motivated to voluntarily excoriate HIV infection (Order of the Ministry of Health No. 295)

• addicts of injectable drugs are stalked in the LPZ when they are killed to the point of being addicted (code 102)
• sickness for illness, which are transmitted by state path (code 104)
• homo- and bisexuality (code 103)
• individuals, as little narcotic, state, medical contacts (“emergency situation”) with ailments for HIV infection (code 120)
• vagina (109 code)
• for special reasons of an individual, who look around, and other reasons (for non-full years up to 14 years - for the prohannya or for the sake of a legal representative) (code 118)

24. Clinical indications for obstetrics for HIV infection (code 113, children and adults)

Overhead display:

• • flirtatious more than 1 month.
  • can improve lymph nodes of 2 and more groups over 1 month;
  • with diarrhea, which lasts more than 1 month;
  • with an unreasonable waste of weight of the body by 10% and more;
  • from protracted and recurrent pneumonia (more than 2 times per rec);
  • women from hr. flaming diseases of organs of unclear etiology;
  • bacterial infections, sepsis, pyoderma;
  • s pіdhostrim encephalitis and bewilderment in early healthy osіb;
  • with hairy leukoplakia of the tongue.

2. Illness with suspected or confirmed diagnosis:

• Kaposi's sarcoma;
• lymphoma of the brain;
• T-cell leukemia;
• Pulmonary and post-degenerative tuberculosis;
• parenteral hepatitis;
• Illness, infection with cytomegalovirus, herpes simplex virus (generalized or chronic forms of infection);
• Pneumocystosis, toxaplasmosis, cryptococcosis, cryptosporidiosis, isosporosis, histoplasmosis, strongidosis;
• Candidiasis of the stravokhod, bronchus, trachea and leg;
• Deep mycosis. Atypical mycobacteria;
• Progressing richly moderate leukoencephalopathy;
• Anemia, leukopenia, lymphopenia of unknown origin;
• Invasive uterine carcinoma
• cervical cancer

24. Stages of HIV infection

1.Stage of incubation (2 days - 3 months) IFA "-" "period"
2. Stage of the first manifestations (1-3 developments)
A. Asymptomatic
B. Gostriy VIL without secondary ailments
V. Gostriy VIL іz dvuhrinnymi ill
3. Latent stage (5-10 years)
4. Stage of secondary illnesses (4A, 4B, 4C) - 3-5 years
5.Terminal stage (SNID) - a few months.

25. Peculiarities of the clinical course of VIL-infection

• Trivality overcoming illness.
• Inevitable fatal result.
• VIL-іnfіkovaniya zalishaєtsya contagious all life.
• Bagatorichny asymptomatic period of illness (on average 7-9 years).

26. Trivality of life for those who are ill for VIL-infection

• Minimum - 3 months.
• Middle - 13 years (half of the patients die).
• The maximum is over 20 years.
• As soon as you are infected, then VIL-infection progresses more rapidly

27. List of illnesses that allow making a diagnosis of SNID in adults with HIV infection

Candidiasis of the trachea, bronchitis, legion.
2. Stravohod candidiasis.
3. Cervical cancer (invasive).
4. Coccidiodomycosis (disseminated or post-legal).
5. Cryptococosis post-legal.
6. Cryptosporidiasis with diarrhea over 1 month.
7. Cytomegalovirus infection (infection of other organs, liver, spleen, lymph nodes in patients older than 1 month).
8. Cytomegalovirus retinitis from the second day.
9.Encephalopathy, confused with VIL.
10. Infection with herpes simplex virus (chronic infections that do not rage for more than 1 month or bronchitis, pneumonia, esophagitis).
11. Histoplasmosis (disseminated or post-legal).
12. Intestinal isosporiasis, chronic (over 1 month).
13. Kaposi's sarcoma.
14. Berkit's lymphoma.
15. Immunoblastic sarcoma.
16. Lymphoma of the brain is primary.
17. Mycobacteriosi, viklicans M. Avium-intracellulare or M. Kansassii or other atypical mycobacteria(disseminated or with lesions of the postures of the leg, skin, shin or other lymph nodes).
18. Tuberculosis legen.
19. Tuberculosis post-legal.
20. Pneumocystis pneumonia.
21. Pneumonia convulsive (2 and more for 1 year).
21. Progressive bagato-seredkovy leukoencephalopathy.
22. Salmonella septicemia.
23. Toxoplasmosis of the brain in patients for 1 month.
24. The Syndrome of Visnazhennya Zumovleny de ієyu ВІL.

28. Diagnosis of HIV infection

1. Epidemiological history (revealing situations of risk and risky behavior for the rest of 6–12 months)
2. Laboratory diagnostics of VIL (blood test for antibodies to VIL and yogo proteins)
3. Clinical review

29. Methods of laboratory diagnostics of HIV infection

Most of the tests do not reveal VIL itself, but antibodies to the new one and the yogo proteins, for the establishment of such an organism, a song hour is needed - so the titles of the vikna period, if not laboratory, it is impossible to recognize with a glance,
Standard laboratory diagnostic procedure
ВІL-іnfektsії є detection of antibodies to ВІL
that yoga protein by enzyme immunoassay methods
(IFA) and immunoblotting (IB)
Sensitivity to become over 99.5%
Call the results of the analysis
reckon how:

• positive;
• sumnіvnі (insignificant);
• negative
• Polymerase Lanzug reaction (PLR):
• it does not indicate antibodies, but the presence of the components of VIL itself (RNA to the virus and yoga virus DNA);
• zastosovuetsya for the purpose of "viral intent" (the amount of VIL in 1 ml of blood plasma) with the method of revealing the moment of antiretroviral therapy and control of effectiveness;
• for early early diagnosis of VIL-infection (for example, in newborn children)

30. The most common occupational risks of infection are:

• • Nursing staff
  • Procedures, posts and operating rooms
  • Medical sisters.
  • Operative surgeons, obstetrician-gynecologists, medical doctors, pathologists.
  • Junior medical staff

31. Officials, in the presence of a risk of infection with VIL:

• ВІL-status of the patient and the stage of illness.
• This patient is on antiretroviral therapy.
• Stage of contamination with an infectious material to the instrument.
• The type of instrument that caused injury.
• The degree of damage to the integrity of the skin curves and the mucous membrane in case of injury to a medical practitioner.
• Dressing of wound surface after injury.
• Timeliness of post-contact chemoprophylaxis of HIV infection with antiretroviral drugs.

32. Most of the emergency situation is blamed for:

Taking blood samples from veins
Internal injections and blood transfusion
Dressed cap on vikoristan head
Transferring contaminated VIL ridin from a syringe into a vial
Cleaning up the work area
Transfer from hand to hand of the state of the art surgical instruments
Unsafe technique of suturing fabrics

33. Come in to prevent the transmission of VIL for the minds of the LPZ:

• Organizational visits
• Zagalni come in prevention
• Preventive visits when working with HIV-infected patients
• Preventive visit in case of emergency

34. Organizational visits

1) Instructions for safety at the work station in the head!
2) Utilization of inputs in accordance with official standards
3) Safe organization of work
4) Provision of medical practitioners by means of defense
5) Availability of the Anti-VIL first aid kit near an easily accessible place

35. Warehouse of the first-aid kit ANTI-SNID Prevention of HIV infection Sanitary and epidemiological rules SP 3.1.5.2826-10 vіd 11.01.11r.

1. 70% ethyl alcohol
2. 5% alcohol tincture of iodine
3. Leukoplastir
4. dressing material
5. syringe for washing eyes
6. distilled water

36. Zagalni come in prevention

• Mitya hands - after the sting of blood, other biological motherlands when passing from one ailing to another
• Dispensers with a rare sweetness and a variety of antiseptics
• Miti relatively stretch 3-5 quills.
• Disposable towels

37. Safe organization of work

• Tell me about all types of injuries during the hour of work with goals, other hospitality items.
• provide trainings, practical exercises in the prevention of infections that are transmitted by parenteral route.
• follow recommendations for the prevention of infections that are transmitted parenterally.

Defend!

• Pull on the caps on vikoristan gols, lamati gols.
• Take a bite, smoke, put on make-up, use a stylish phone, put on lenses at work, make contact with blood and biological motherlands.
• Raise with bare hands the ulamki skla
• Get some hands out of containers for vikoristany prickly and cutting tools
• Vykoristovuvat re-disposable mittens.

38. Preventive visits in case of emergency.

1. For injections, take off your mittens, take off your hands with running water with a darling. In case of bleeding, see blood, treat the wound with 70% ethyl alcohol, then 5% iodine. Chi do not rub! Seal the wound with adhesive plaster or apply an aseptic bandage.
2. If blood and other biological wounds get on the skin on the curve of the body, they should be treated with 70% alcohol. Wash with warm water and re-treat with 70% alcohol.
3. If BZh/blood gets on the mucous eyes, rinse with running water.
4. If BR/blood gets into an empty mouth, rinse with 70% ethyl alcohol. Chi do not beat!
5. If blood and other biological roots of the patient get on the dressing gown, clothes: take work clothes and put them in a disinfectant rozchin or bix (tank) for autoclaving.

It is necessary in a short term after exposure to HIV and viral hepatitis B and C, a person who may have been in contact with him.
Examination for VIL of a potential case of VIL-іnfektsії and individuals who were in contact should be carried out by the method of express testing for antibodies to VIL after an emergency situation with obov'zkovymi directions of the test for a standard test vanya on VIL in IFA.

39. Preventive visits in case of emergency

Negaino get used to preventive visits. Carry out ARV therapy as early as possible. After the age of 72, ARVT was not administered adequately.
2) Tell me about those that happened to the engineer of the structural subdivision of LPZ.
3) Register the fact of the accident with the journal in the form of emergency situations, which can be checked with the skin department.
4) Establish VIL-status of the patient, type of injury, take epidemiological anamnesis.
5) Return for a consultation to the SNID Center
(village Mekhanichny, 2. tel. 25-80-32.)

40. Principles of chemoprophylaxis of parenteral transmission of VIL

• Start chemoprophylaxis of yakomoga earlier, or even in the first 2 years after a possible infection.
• Be it from high-intensity therapy schemes.

How її it’s impossible to rozpochat right behind the scheme high intensity therapy, yakomoga earlier it is necessary to administer medications, obviously.

• After the age of 72, the cob of chemoprophylaxis and the expansion of the її scheme is stupid.

41. Principles of chemoprophylaxis of parenteral transmission of VIL:

It has been proven that the risk of infection is reduced by 79% per hour of the change of the scheme:
Zidovudin (thimazid, retrovir) - orally, 0.2 g 3 times (or 0.3 dvіchі) for doba for 4 tizhnіv.
Nikavir (phosphazide) - orally, 0.4 (2 tablets) 2 times a day for 4 days.

Although greater efficiency has not been achieved, at this time, chemoprophylaxis is recommended for combined antiretroviral therapy regimens (three preparations) for 4 periods from the moment of the accident.
scheme of post-exposure prophylaxis of HIV infection - lopinavir/ritonavir (Kaletra) 2 tablets per day and zidovudine/lamivudine (combivir) 1 tablet per day for 4 days.
For the availability of these drugs for the cob of chemoprophylaxis, there may be other antiretroviral drugs;
Care of a medical practitioner after an accident - 12 months.
Counseling directed at the psychosocial support of the victim.
The medical practitioner is recommended to use a condom until the end of the guardianship when making contacts.
Laboratory obstezhennya: immediately after the medical treatment and on the cob of chemoprophylaxis then after 1 month, 3, 6 months and after 12 months after the accident.
All health care providers are responsible for the safety of the mother, if necessary, access to rapid tests for HIV and antiretroviral drugs. The stock of antiretroviral drugs is responsible for saving up in any health care facility for the choice of health care management bodies in the Russian Federation, and even with such a rozrahunkom, so that the provision of that treatment could be organized for 2 years after the accident new situations. In the upgraded health care facility, there may be appointments for fahivets, depending on the need for taking antiretroviral drugs, taking care of access, including night hours and weekdays.

Registration of an accident in the accident log:
Date____.____.____., hour_____year_____hv
PIB medical practitioner _____________________________
Posada of a medical practitioner ________________________
manipulation ________________________ short description of the accident ____________________________ come on in ____________________________

signature of head pіdrozdіli (at the night hour of the chergovy and vіdpovіdalny doctor) _____________

signature of the senior honey. sisters _____________

43. Data about the patient, help for which the accident has become

PIB_______________ date of birth ___.___.___.
addresses ______________________________________
telephone___________________________________

VIL-status:
- stage VIL-infection
- what is the patient on therapy
- RNA in plasma
- number of CD4, CD8 lymphocytes, their expression

Presence of parenteral viral hepatitis
Federal Law No. 122. Article 22. Guarantees in the sphere of practice.
2. Practitioners of enterprises, having established the organization of the sovereign system of health care, as a way to diagnose and treat VIL-infections, as well as individuals, the robot of such cases is connected with materials to avenge the virus on immunodeficiency people, pіdlyagayut:
- obov'yazykovy insurance at different zapodіyannya shkodiїh zdorov'yu chi death at vikonnі service obov'yazkіv according to the procedure established by the legislation of the Russian Federation;
- obov'yazykovy social insurance against unfortunate events on the prevention of professional illnesses in accordance with the procedure established by the legislation of the Russian Federation.

44. Legal aspects of HIV infection

Rivni legislation
International legislation
The declaration on the right to fight against VIL / SNID was adopted at a special session of the UN General Assembly from VIL / SNID, 25–27 March 2001.

Russian (domestic state) legislation
Federal Law of March 30, 1995 No. 38 “About the spread of illness in the Russian Federation, as it is called by the human immunodeficiency virus (VIL-infection)”

45. Main areas of regulation

Equal rights and bindings
Vidpovidalnist for the creation of the minds of a possible infection with VIL
Right to privacy
The right to be kind
VІL-іnfіkovanі citizens of the Russian Federation mayut on the її territory all rights and freedoms and bear obligations in accordance with the Constitution of the Russian Federation

46. ​​Right to the protection of health

The state guarantees the skin hulk of protection against any form of discrimination, slandered by the presence of some kind of illness
Vіdmova doctor vіd nadannya medical assistance
criminal mischief (article 124 of the Criminal Code of the Russian Federation)

The patient has the right to:

• choose a doctor and a liquor mortgage;
• saving from the taєmnitsі іnformatsії;
• choose osib, to whom the information will be transferred;
• collection of information about the state of health;
• dobrovіlna poіnformovana zgoda on carrying out medical introductory or vіdmova vіdny;
• retrieving information about your rights and bindings

47. Right to privacy

The Constitution of the Russian Federation guarantees the right of the skin to the lack of privacy of private life, special and family secrets, defense of one's honor and good name
Federal Law No. 323-FZ of November 21, 2011 (as amended on June 25, 2012) "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation".
Confidential information:

• the fact of the animal for medical assistance;
• about the camp of health;
• about the diagnosis of illness;
• іnshі vіdomosti, otrimani pіd h obstezhennya i kuvannya

Vіdpovіdno up to the dignified legislation of the individual, as it was passed to the statements, to establish a medical mystery, equals with medical and pharmaceutical practitioners, carry a disciplinary, administrative and criminal liability for the speech of these statements

Kozhen Gromadyan of the Russian Federation may have the right to look around at VIL:
voluntarily or for good (clause 3, article 7);
anonymously behind the bazhannyam (clause 2, article 8);
bezkoshtovno at the mortgages of the protection of health (clause 7, article 7);
with previous and upcoming consultations (clause 6, article 7);
at the presence of a legal representative (clause 4, article 7);
not full-time for up to 14 years - for the prohannya or for the sake of the year of their legal representatives (clause 1, article 7)

49. Obov'yazkovy look at VIL-infection

• Stosuetsya less than okremikh categories of osib
• (Article 9 of the Federal Law No. 38-FZ)

• blood donors, biological mothers, organs and tissues;
• practitioners of other professions when entering a job and at periodic medical examinations;
• foreign hulks and individuals without hulks, like arriving to the Russian Federation by the term over three months
• Rules for conducting obov'yazkovy medical
• look at VIL-infection
• Decree of the Order of the Russian Federation

50. The right of a VIL-infected individual to withdraw information about the results of a medical examination

• When VIL-infection was detected, a person who passed
• medical examination
• practitioner of the medical installation, who conducted
• look around:
• about the results of looking around;
• about dotrimannya zakhodіv z metoyu vyklyuchennya expansion of VIL-іnfektsії;
• about the guarantees of the rights and freedoms of VIL-іnfіkovanyh;
• about the criminal liability for the delivery of an infected person to the non-safety of an infected individual

51. Traces of manifestation
VIL-infections

• In times of manifestation of VIL:
• the citizens of the Russian Federation cannot be known as blood donors, biological mothers, organs of the prosecutor's office and tissues;
• foreign communities that individuals without community, who are located on the territory of the Russian Federation, are deported from the Russian Federation

52. Criminal liability for HIV infection (Article 122 of the RF CC)

• Svіdome put іnshої іnshої іnshої іnshої іnshої individuals іn thе nezpezpekі vіl-infektsієyu - kaєmzhennym volі on lines up to three years, or arrest on lines vіd three to six months, or liberated volі on lines up to one fate.

• Infection of another individual with VIL-іnfektsієyu special, as she knew about the presence of her sickness, is punishable by free will on lines up to five years.
• Subject of evil: VIL-іnfikovana person, yak reached 16 years

Qualification warehouse (for warehouses 1, 2) - usually two and more osib, or if an incompetent individual is transferred at the discretion of the will on lines up to eight years.

Note: The person, yak, made a mistake, transferred hours. 1, 2 art. 122 of the Criminal Code of the Russian Federation, it is called out in case of criminal activity in a case, as if it were another person, placed in the safe zone of infection or infected with VIL-infection, it was timely informed about the first person’s illness and voluntarily it was a good time to instigate what they did to the unsafe infection.

Infection of another individual with VIL-infection due to improperly wearing a special one of their professional shoes is punishable by up to five years of freedom in the lines of the exemption of the right yalnistyu on lines up to three rokiv.
The subject of mischief: a medical practitioner, who destroyed the outside, which led to the infection of the individual with VIL-infection.

Prevention of HIV infection

Sanitary and epidemiological rules

SP 3.1.5. 2826-10

III. burning position

3.1. VIL infection– ailment, viklikana human immunodeficiency virus - anthroponotic infectious chronic disease, which is characterized by specific lesions of the immune system, which can lead to full collapse to the formation of the syndrome of full immunodeficiency (CH ID), which is accompanied by the development of opportunistic infections and secondary malignancies.
3.2. The diagnosis of VIL-infection is established on the basis of epidemiological, clinical and laboratory data.
3.3. SNID is a camp that develops against the background of VIL-infection and is characterized by the appearance of one number of ills, which are brought to SNID-indicator. SNID є epidemiological understanding and victorious with the method of epidemiological observation of VIL-infection.
3.4. Zbudnik ВІL-іnfektsії – the virus of human immunodeficiency – is considered to be a subtype of lentiviruses of the family of retroviruses. There are two types of virus: VIL-1 and VIL-2.
3.5. Dzherelom VIL-infections are people infected with VIL at any stage of illness, including in the incubation period.
3.6. Mechanism and transmission factor.
3.6.1. ВІL-іnfektsіya can be transmitted under the hour of implementation both natural and piecemechanism of transmission.
3.6.2. Before the natural mechanism of transmission VIL lie:
3.6.2.1. Contact, which is realized more importantly with state contacts (both with homo- and heterosexual ones) and with contact of the mucosal or wound surface with blood.
3.6.2.2. vertical
3.7.3. Prior to the piece transmission mechanism, lie:
3.7.3.1. Artifical in non-medical invasive procedures, including intravenous injection of drugs (various syringes, needles, other injectable materials and materials), tattooing , when performing cosmetic, manicure and pedicure procedures with non-sterile instruments .
3.7.3.2. Artifical in case of invasive involvement in LPO. IVL infection can be caused by blood transfusions, transfusion components, organ and tissue transplants, donor sperm, donor breast milk from an IVL-infected donor, as well as through medical instruments for parenteral insertion, due to medical recognition, contamination with VIL and yaki did not know the identity of with the help of normative documents.
3.8. The main factors in the transmission of the disease are the biological origins of the human being (blood, blood components, semen, vaginal discharge, breast milk).
3.9. The main different VIL-іnfektsієyu groups of the population є: svozhivachі іn'єktsіynyh narcotics (СІН), commercial sex-practitioners (SSR), people, yakі have sex with people (ChSCh). The group of increased risk of infection with VIL is represented by CRW clients, state partners of SIN, affected, homeless children, individuals, who may have a large number of state partners, migratory populations (long-distance water carriers, seasonal workers, including foreign communities who work on a rotational basis and others), people are addicted to alcohol and non-infectious drugs, shards under the influx of psychoactive speeches and stench often practice unsafe sexual behavior.
3.10. Clinical breakthrough of HIV infection without stoppage of antiretroviral therapy.
3.10.1. Incubation period
The incubation period for VIL-infection is the first period from the moment of infection until the body is infected with the virus (the appearance of clinical symptoms or the production of antibodies) becomes, as a rule, 2-3 days, or it can be delayed up to 3 -8 months, sometimes up to 12 months. In this period, the infected antibody to VIL does not show signs of increased risk of transmission due to infection in the internal follicles, including those with blood transfusions and those components.
3.10.2. Gostra VIL-infection.
In 30-50% of infections, symptoms of acute HIV infection appear, which are accompanied by various manifestations: fever, lymphadenopathy, erythematous-maculopapulosic visip on the face, tulub, on the nose, mial gії or arthralgia, diarrhea and spleen, neurological symptoms. Qi symptoms show up on aphids of high viral infection in different cases and may have different levels of virality. In lonely cases, already at this stage, severe secondary illness can develop, which leads to the death of patients. In this period, there is an increase in the frequency of turnover of infections in health care facilities; The risk of transmission of infection is high, at the link with a large amount of blood virus.
3.10.3. Subclinical stage.
The trivalence of the subclinical stage in the middle becomes 5-7 years (in the case of 1 to 8 years, sometimes more), clinical manifestations, crimoma of lymphadenopathy, every day. At this stage, without manifestations of infection, there are three times of infection. Under the hour of the subclinical period, the reproduction of VIL and the decrease in the number of CD4 lymphocytes in the blood continue.
3.10.4. Stage of secondary ailments.
On the aphids of the growing immunodeficiency, there are secondary illnesses (infectious and oncological). Illness on infections of a viral, bacterial, fungal nature on the back of the head is pleasantly treated and bathed in the most therapeutic methods. On the back, it is more important to damage the skin and mucous membranes, then the organs and generalized damage, which leads to the death of the patient.
3.11. Antiretroviral therapy (ART) - etiotropic therapy for HIV infection. At the current stage, ART does not allow the elimination of VIL from the sick organism, but it prevents the virus from multiplying, which will lead to the restoration of immunity, preventing the development or regression of secondary illnesses, saving or slowness of the patient's practice and the fear of his death. Effective protiretroviral therapy is one-hour and prophylactic approach, which reduces the risk of the patient as a dzherel infection.

IV. Laboratory diagnosis of VIL-infection

4.1. Laboratory diagnosis of VIL infection is based on the presence of antibodies to VIL and viral antigens, as well as, in particular cases, the presence of VIL proviral DNA and VIL viral RNA (in children of the first life).
4.2. Laboratory investigations for the diagnosis of VIL-іnfektsії are established in the establishments of the state, municipal or private health care system on the basis of the sanitary and epidemiological certificate and licenses, which are hoped to be in order, in established by the legislation of Ukraine.
4.3. The standard method of laboratory diagnosis of VIL-infection is the determination of antibodies / antigens to VIL with additional ELISA. To confirm the results of how VIL are tested, a confirmation test (immune, linear blot) is carried out.
4.4. Diagnostic algorithm for testing for the presence of antibodies to VIL:
4.4.1. At the first stage (screening laboratory).
Once a positive result in the IFA is taken, the analysis is carried out 2 more times consecutively (with the same test system and in the same test system, the other mother is tested only at the time of impossibility to direct further follow-up of the first milkweed). Yakshcho is Otromyo Two positive results in the IFA, sirovatka, it is to be the primary-positive I directs to the reference laboratory (laboratory of the DIL-INFOSICA Center for the Center for the Profigyt Zi Snіd) for the filed doslizlijeennia.
4.4.2. At another stage (reference laboratory).
Primarily positive serosa is re-tested in IFA with another test system of another sample, as it is examined first for the stock of antigens, antibodies or test format, taken for confirmation. If the result is negative, the serosa is re-admitted to the third test system of the other tester, as it is tested first and foremost for the warehouse of antigens, antibodies or test format. In case of a negative result (in other and third test systems), there are signs of the presence of antibodies to VIL. If a positive result is withdrawn (for another and/or third test system), the serum must be continued in the immune or linear blot. The results, rejected in the test, which are confirmed, are interpreted as positive, non-significant and negative.
4.4.2.1. With the method of ensuring the control of this form, the reference diagnostics is due to the same subject of the Russian Federation, where the screening was carried out in the laboratory of an approved specialized health care facility, which іyno-methodical work of carrying out diagnostic, likuvalnyh, prophylactic and anti-epidemic visits to VIL- ill infections.
Reference diagnostics can also be carried out at the FGUN, on the basis of the federal and regional centers for the prevention and control of SNID, and at the Federal State Institution Republican Clinical Infectious Diseases Hospital (St. Petersburg).
4.4.3. Positive (positive) samples are considered, in which antibodies up to 2 of 3 glycoproteins BIL (env, gag, pol) are detected.
4.4.4. The negative (negative) ones are considered to be siroworts, in which there are no antibodies to the same antigens (bіlkіv) VIL or a weak reaction with the p18 protein.
4.4.5. Insignificant (doubtful) sirovatkas are important, in which antibodies are detected up to one glycoprotein VIL and/or be it VIL proteins. In case of rejection of an unassigned result with a protein profile, which includes core proteins (gag) p 25, follow-up is carried out for the diagnosis of VIL-2.
4.4.6. In case of rejection of the negative and summative results in the immune or lineal blot, it is recommended to continue the test system for the assignment of p24 antigen or DNA/RNA VIL. As a result, p24 antigen or VIL DNA/RNA was detected, re-expanding in the immune or linear blot should be carried out 2, 4, 6 days after the first non-significant result.
4.4.7. In case of rejection of an unsigned result, repeated follow-up of the antibody to VIL immune or linear blot after 2 weeks, 3 and 6 months is carried out. Even if negative results in the IFA are taken away, further follow-up is not necessary. Even after 6 months after the first exposure, the results will be canceled again, and the patient will not show the risk factors of infection and clinical symptoms of VIL-infection, the result will be considered as chibnopositive. (For the presence of epidemiological and clinical indications, serological follow-ups are repeated for the indications of a doctor or an epidemiologist).
4.5. For the diagnosis of VIL-infection in children under 18 months of age, born by VIL-infected mothers, other tests are required in connection with the presence of maternal antibodies.
4.5.1. For the diagnosis of VIL-infection in children up to 12 months of age, born by VIL-infected mothers, vicorist method, creation for the detection of the genetic material of VIL, (DNA and RNA). Removal of positive results of infection for IVL DNA or IVL RNA in two samples of blood taken from children older than one month - laboratory confirmation of the diagnosis of HIV infection. The addition of two negative results of the infection for VIL DNA and VIL RNA in children 1–2 months and 4–6 months (during the day of breastfeeding) testify against the presence of HIV infection in children, prosthesis of children with dispan sulfur appearance with the drive of intranatal and perinatal contact with VIL-infection can be carried out in women older than 1 year.
4.5.2. The examination of the dispensary appearance of VIL-infection in the first 18 months is carried out with an one-hour presence:
– two and more negative results for antibodies to VIL by ELISA;
– 24 hours of severe hypogamaglobulinemia at the time of blood count for antibodies to VIL;
- Number of clinical manifestations of VIL-infection;
4.5.3. Diagnosis of VIL-infection in children born by VIL-infected mothers and for 18 months, develops the same way as in grown-ups.
4.6. Laboratory diagnostics of VIL-іnfektsії can only be done for the sake of understanding the certification of standardized diagnostic test systems (sets), which are allowed for the vikoristannya of the Russian Federation in order.
With the method of carrying out an input control of the vigor test-systems for the detection of cases infected with the human immunodeficiency virus, the standard panel of sirovats (galuzevy standard zrazki) is allowed to vikoristannya in the established order.
4.7. The documents that are seen by the laboratory for the results of the follow-up should indicate the name of the test system, the term of applicability, the series, the result of the ELISA (positive, negative), the result of the immunological, linear blot (translation of the detected proteins and visnovok: positive, negative , omissions). When confidentially submitted, the document may contain passport data: surname P.І.B., date of birth, address of place of residence, contingent code. Under the hour of anonymous processing, the document is marked with a specially inserted code.
4.7.1. If the summative result is canceled in the confirmation test (immune, linear blot), there are signs of non-significance, the result of follow-up and it is recommended to repeat the patient's obstetrics until the status is determined (after 3, 6, 12 months).
4.8. Simple/fast tests for the identification of specific antibodies to VIL - all tests, as it is possible to test without special possession for less than 60 quilin . As additional material, blood, sirovatka, blood plasma and slin (zishkrib z mucosal ).
4.8.1. Areas of focus on simple / quick tests:

• transplantology – before the collection of donor material;
• donation – blood clots, in case of emergency transfusion of blood preparations and the presence of blood clots for antibodies to VIL of donor blood;
• vertical prevention – testing of pregnant women with unknown HIV status in the pre-maturity period (for the recognition of drug prevention of HIV infection during the first half hour);
• post-exposure prophylaxis VIL – testing for VIL in emergency situations;

4.8.2. Skin follow-up on VIL due to simple/sweet tests is due to be accompanied by obligatory parallel follow-ups of blood portions by classical methods of IFA, IB.
4.9. It is not allowed to show a visnovka about the presence of VIL-infection beyond the results of a simple / swedish test. The results of simple/sweet tests are only used for immediate praise of solutions in emergency situations.

V. Procedure for looking back at VIL-infection

5.1. The main method for the detection of VIL-infection is the testing for antibodies to VIL with obov'yaskovym and post-test consultations. The presence of antibodies to VIL is evidence of the presence of VIL infection. A negative result of testing for antibodies to VIL does not always mean that the person is not infected, but there is a period of “seronegative vikn” (an hour between infected with VIL and the appearance of antibodies, which will become close to 3 months).
5.2. A look at VIL-infection is carried out voluntarily, for a wink of vipadkiv, if such a look is obov'yazkovim.
Obov'yazykovy medical look at VIL-іnfektsіyu pіdlyagayut:
- donors of blood, blood plasma, sperm and other biological mothers, tissues and organs (including sperm), as well as during the sampling of abortive and placental blood for the selection of biological preparations for skin sampling of donor material;
Obov'yazkovoy medical examination for the detection of VIL-іnfektsії pіd an hour I will enter the work, and during periodic medical examinations, practitioners will do the following:
Physicians, middle and young medical personnel of the centers for prevention and control of SNIDom, establishments of health care, specialization and structural support of health care, occupied by non-intermediate obstezhenny, diagnostics, likuvannyam, services, as well as the conduct of a shipboard medical examination in. human immunodeficiency virus, yakі may have direct contact with them;
- doctors, middle and junior medical personnel of laboratories (groups of laboratory personnel), as a result of exposing the population to VIL-infection and additional blood and biological materials, taking away the virus, human immunodeficiency virus ;
- scientists, specialists, servicemen and workers of scientific and advanced institutions, enterprises (virbnitstv) in the preparation of medical immunobiological preparations in and other organizations, the work of such po'yazana with materials to avenge the virus of immunodeficiency people neither.
- medical practitioners at hospitals (institutions) of a surgical profile upon entry into work and work 1 time per day;
- Individuals who pass the military service and join the military primary mortgages and the military service for a prize and a contract, with a prize for a line military service, when they enter the service for a contract, when they join the military VNZ ministries and departments that establish an exchange for admission omu to the service of OSIB from VIL-іnfektsієyu;
- Foreign hulks and individuals without hulkiness in case of animal husbandry for the removal of permission for hulkiness either with a view to living, or with a permit for a job in the Russian Federation, when entering the territory of the Russian Federation of foreign hulks with a term greater than 3 -x months.
5.3. For bajannyam individuals who look around, dobrovіlne testuvannya on VIL can be anonymous.
5.4. Medical practitioners are responsible for recommending to persons who are at risk of HIV infection, have a regular check-up on HIV infection for early detection of HIV infection, counseling with nutrition of HIV infection tsії that svoєchasno cob likuvannya in times of infection.
5.5. A look at VIL-іnfektsіyu (among others, anonymous) is established in the medical institutions of all forms of power for the informed well-being of patients in the minds of suvoro Confidentiality, and in times of 14 years – on prohannya or for the sake of yogo legal representative.
5.6. Looking back at VIL-infection, it is carried out with obov'yazkovym dota-post-test consultations for nutritional prevention of VIL-infection.
5.7. Guilty counseling is carried out by a doctor-infectionist (physician-infectionist, physician-epidemiologist or a psychologist) and includes the main provisions that are subject to testing for VIL, possible traces of testing, designation of obviousness or daily of individual factors risk, assessment of the prevalence of VIL prevention, which is based on the nutrition of prevention . information about ways to transmit VIL and how to protect yourself from infection with VIL, seeing additional help available for an infected VIL.
5.8. When conducting a pre-test consultation, it is necessary to fill in the form for information on the examination of HIV infection in two conciliators;
5.9. Directly on the research in the enzyme immunoassay of the blood test for VIL-infection, all health care facilities are established regardless of the organizational and legal form and form of authority.
5.9.1. With a candidentine test, the Personal Dan is to be guided by Patzіnta without a speed (behind the passport of an aboard, Ido is a deputy, the navigation of a special person): P.I. B., all the date of the people, enormances, addresses of the Moscow Life, Code of Cont v.
5.9.2. In case of anonymous testing (without a passport), only a digital code is indicated, which includes the serial number of the tested person, country of origin, place of residence (subject of the Russian Federation). A nickname, im'ya, is not indicated by the father.
5.10. Feedback about the result is seen after the completion of the testing algorithm. The appearance of an official document about the presence or presence of VIL-infection in an individual who is obese is only established by the state or municipal system of health protection.
5.11. The results of the test for VIL after the examination are advised by the consultant during the post-test consultation; if possible, one and the same fahivets should be carried out before that last test consultation of the patient.
5.11.1. Counseling for any result of testing for VIL is due to discuss the significance of the taken away result from the improvement of the risk of infection with VIL for the patient; types of help available for infected VIL, and recommendations for further testing tactics.
5.11.1.1. Consultation in case of an unrevealed result of testing for VIL for an addition to the complex of standard information may be possible to discuss the possibility of VIL infection, the need for additional follow-up visits with the method of preventing the expansion of VIL-infection , guarantees of medical assistance, exaltation, gaining the rights and freedoms of HIV-infected people. The tests are sent to the Center for Prevention and Control of SNID.
5.11.1.2. The person who has been diagnosed with VIL-infection informs the consultant about the results of the test. Fahivets report a positive test result in a clear and short form, give an hour for receiving the test, confirming the nutrition of the stalker. Roz'yasnyuє nebhіdnіє dotrimannya zabobіzhnyh zahodіv z metoyu vyklyuchennya
rozvsyudzhennya VIL-іnfektsії, about the guarantees of medical assistance, expiation, granting the rights and freedoms of VІL-infections, as well as about criminal liability for causing unsafe infection or infection of another individual. Testing is sent to establish the diagnosis of VIL-infection, and provide medical assistance to the Center for the Prevention and Control of AIDS.
5.11.2. The results of the follow-up are not reported by the phone.
5.11.3. The diagnosis of a disease caused by the human immunodeficiency virus is established by a doctor at the Center for Prevention and Combating SNID or by an uplifting doctor at the LPO on the basis of a complex of epidemiological data, the results of clinical examination and laboratory reports jen. Diagnosis VIL-іnfektsії podomlyaєєєєєєєєє patients і іnfektsіonistom (bzhanі likar-іnfektіonistom, likar-іpіdemiologiya аbo psychologist) pіd hour konsultovanija patsiєnі іn the Centerі і profіlakіtsі i bortbі zі SNID аbо u upgraded LPZ. The patient is informed in writing about the manifestation of VIL-infection, and he hopes to receive information about any problems. At the time of the manifestation of VIL in non-old age up to 18 years, their fathers and legal representatives are seen.

VI. Organization of dispensary care for sick people with VIL-infection

6.1. The method of dispensary care for HIV-infected patients is to increase the anxiety and save the quality of their life. The main tasks are the formation of sickness to the dispensary guarding, their own indications for the admission of antiretroviral therapy, chemoprophylaxis and the treatment of secondary illnesses, the safety of giving them their own medical assistance , among them there are psychological encouragement and exuberance of concomitant illnesses.
6.2. VІL-іnfіkovanі individuals grant the request for primary and periodic obstetrics, but if not guilty, they violate their right to vidmova vіd obstezhennia and likuvannya, as well as the right to stay in a medical setting for their own choice, we say in the letter in your form.
6.3. Individuals with a diagnosis of HIV-infection may be taken to the dispensary for the prevention of HIV-infection. The dispensary guards the establishment of health care facilities, upovnovazhenie by an ordering act to the body managing the health care of the subject of the Russian Federation.
The dispensary can also be established at the FGUN, on the basis of the federal and regional centers for the prevention and control of SNID, and at the Federal State Institution Republican Clinical Infectious Diseases Clinic (St. Petersburg).
6.4. For the skin disease of VIL-infection (in addition, with a positive laboratory result for VIL-infection sectional material), an epidemiological examination is carried out by specialists of the SNID center and, if necessary, by specialists of organs, yakі zdіysnyuyut sovereign epidemiological view. On the basis of the results of the epidemiological investigation, there are reports about the causes of illness, infection, routes and transmission factors of VIL-infection, which caused the illness. With the improvement of this development, a complex of preventive and anti-epidemic approaches is being implemented, which includes the development of infectious diseases and contact issues, recognition of the benefits of specific and non-specific prevention.
6.4.1. In case of suspicion of internal infection, epidemiological investigations are carried out by the authorities of the organs, as a way of establishing the state epidemiological outlook, together with the authorities of the Centers for SNID and/or the authorities of the FGUN, on the basis of their functional t federal and regional centers for prevention and control of SNID, FGU. St. Petersburg), from the study of the necessary experts.
Behind the skin type of internal infection, a complex of preventive and anti-epidemic approaches is developed to localize the cavity and prevent further spread of infection, an "Act of epidemiological investigation" is formed.
6.4.2. An epidemiological investigation of the nature of the partners’ partners and those of the partners regarding the introduction of drugs is carried out using the “partner notification” method (in the case of an IVL-infected individual, the identification of contact details is carried out, and individual consultations are carried out with them for nutritional prevention VIL-infections). Infected VIL hopes to be able to either independently inform partners about the risk of infection VIL and request a consultation to the SNID center, or give the consultant contact information about partners (call the partner’s name and phone number) for a consultation request. The consultant is guilty of recklessly adhering to the principle of anonymity of information and guaranteeing the first and all future participants of the notification of full confidentiality.
6.5. The dispensary care for children is established by the pediatrician to the Center for SNID together with the pediatrician of the LPO.
6.6. Under the hour of the reception of the doctor, to carry out psychological adaptation of the patient, determine the extent of the obstezhennia and likuvannya, evaluate that form of acceptance before therapy.
6.7. Advice on the nutrition of VIL-infection should be carried out in case of skin disease for VIL-infection as part of a dispensary follow-up.
6.7.1. If you are careful about VIL-infected children, you should consult on the issues, how to keep an eye on the child, that osib, how to be legally responsible for the child. Consultation of children with HIV-infection nutrition is carried out on a regular basis until age-old features.
6.8. In case of dispensary alertness, consulting is carried out, planned before the admission of antiretroviral therapy, and during antiretroviral therapy, it is necessary to comply with the basic standards, recommendations and protocols. It is necessary to provide regular coverage of VIL infections for tuberculosis (not less than 1 time per 6 months) and opportunistic infections, as well as preventive maintenance of tuberculosis and pneumocystis pneumonia to all who require vymog normative documents.
6.9. Treatment of ailments for VIL-infection is carried out on a voluntary basis and includes offensive directives: psychosocial adaptation of the patient, antiretroviral therapy, chemoprophylaxis of secondary ailments, treatment of secondary and concomitant ailments b.
6.9.1. Antiretroviral therapy is etiotropic therapy for VIL-infection, which should be carried out beforehand. Її recognition and control of efficiency and safety is established by the Center for Prevention and Control of SNID of the subject of the Russian Federation. This function can be carried out by the FGUN, on the basis of such functioning federal and regional centers for prevention and control of SNID; FDM Republican Clinical Infectious Diseases Clinic (St. Petersburg), as well as LPO under the Methodical Care Center SNID.
6.9.2. To assess the effectiveness and safety of ART within the framework of the dispensary follow-up, regular follow-up of viral infection, CD4 lymphocyte count, clinical and biochemical blood follow-up, instrumental clinical follow-up are carried out. The main criterion for the effectiveness of ART is the reduction of viral exposure to an insignificant level.
6.9.3. Efficient (with the reach of an undetermined level of viral attack) antiretroviral therapy is, among other things, a preventive approach that reduces the patient's unsafety like a dzherel infection.
6.10. When VIL infections are detected, if they are transferred to inpatient treatment, they should ensure the consultation of an infectious disease specialist to the Center for SNID, laboratory investigations, necessary for clarifying the stage of infection and the severity of nutritional not antiretroviral therapy.
6.11. In order to improve the effectiveness of dispensary care and form the admission to antiretroviral therapy, it is possible to win a multiprofessional education from an educated doctor, nurse, high medical faculty, psychologists, social scientists practitioners, training consultants from the number of HIV-infected people. The formation of patient acceptance before dispensary care is based on the technology of consultation within the patient-centered approach.

VII. Sovereign sanitary and epidemiological outlook on VIL-infection

7.1. An epidemiological outlook on VIL-infection – the whole system of constant dynamic and rich aspect ratio behind the dynamics and structure of disease (infection) given by infectious disease, which in the human population is due to the connection with the specificity of a pathogenic agent (biological factor), which is likav іnfektіynyy protsess, and іznimi social-demographic and behavioral characteristics of people.
7.2. The method of sovereign sanitary and epidemiological supervision of VIL-infection is an assessment of the epidemiological situation, trends in the development of the epidemic process; care for the hospitalization of the population with prevention, dispensary guarding, rejoicing and support in case of VIL-infection, effective visits, which are carried out for the adoption of administrative decisions and the development of adequate sanitary-protidemic (preventive) ) ​​entering, directing to reduce the incidence of HIV infection; early formation of group diseases for VIL-infection, important forms and lethal outcomes.
7.3. Sovereign sanitary and epidemiological oversight of VIL-infection is carried out by authorities, as a state sanitary and epidemiological oversight.
7.4. Detection, appearance and registration of ailments for VIL-infection and obstezhennia for VIL should be carried out in a viable manner until the recovery of symptoms.
7.4.1. Skin susceptibility to VIL-infection (positive result of follow-up in the immunoblot) influencing the registration and appearance of the manifestations in LPO, regardless of the presence and forms of power. The shape of the patient's residence is carried out for the organization of dispensary care and treatment.
7.4.2. Information about the positive result of the blood test for VIL in immune blotting from the reference laboratory is transmitted to the screening laboratory and / or the health care facility that sent the material for review, as well as to the territorial authorities that influence the state sanitary and epidemiological overview, Federal Scientific and Methodological Center for Fighting zі SNID. When VIL-infections are detected in nonresident residents of the Russian Federation, information is transmitted to the territorial center for prevention and fight against SNID for the patient's permanent registration.
7.4.3. When a positive result is obtained for VIL from a blood donor, organs and tissues, information from the reference laboratory is transmitted for 24 years by phone to the blood service (blood transfusion station, blood transfusion station) and to the territorial organs, I kі zdіysnyuyut state sanitary and epidemiological outlook . .
7.4.4. Pozachergove information about the skin type of VIL infection in likuvalno-prophylactic organizations, or suspicions of a new one are transmitted to the authorities, as a result of the state sanitary and epidemiological supervision of the subject of the Russian Federation, to the Federal authority, what a modern sanitary and epidemiological view of the Russian Federation and the Federal Scientific methodological center and struggle against SNID.
Upon completion of the epidemiological investigation, the Act of Epidemiological Investigation is sent to the Federal Authority for the Health and Epidemiological Review of the Russian Federation and the Federal Scientific and Methodological Center for the Prevention and Control of SNID.
7.4.5. LPO, which changed or clarified the diagnosis, filed a second report on the sick person for VIL-infection to the Federal Scientific and Methodological Center for the Prevention and Fight against SNID and the Territorial Center for the Prevention and Fight against SNID for the Permanent Life registration of the patient, indicating the change of his installation at the time :
– determination of the causes of infection with VIL-infected,
– establishing the diagnosis of SNID,
– stating the death of a VIL-infected sick person on SNID,
– change the place of residence of the patient,
– understanding the diagnosis of VIL-infection,
– visnovki about the presence or presence of HIV-infection in a child born to a HIV-infected mother.
7.5. LPO, how can laboratories, how to carry out follow-up on VIL, independently in organizational and legal forms, forms of power and authority, including FGUN, on the basis of federal and district centers for the prevention and control of SNID, F DM "Republican Clinical Infection likarnya” to provide information about the results of blood testing for antibodies to VIL (monthly form No. 4 of the federal state statistical alert) to the center for prevention and control of CVID of the subject of the Russian Federation, in order to conduct testing for VIL.
7.6. The organization responsible for the sanitary and epidemiological review of the subjects of the Russian Federation, the health management bodies of the subjects of the Russian Federation, to ensure the monitoring and evaluation of the effectiveness of the entry of prof. The practice and treatment of VIL-infection in the subjects of the Russian Federation is likely to be confirmed by indicators , that send the results of the monitoring to the Federal body, zdіysnyuє sanitarno-epіdemiologichnіchny vіdpovіdno pіdpovіdno vstanovih vimog.
7.7. Information about the diagnosis of VIL-infection without the need of a citizen or one legal representative is allowed at the examinations, transferred by the legislation of Ukraine:
– with the method of obstezhennya that exultation of a hulk who is not built through his camp to hang his will;
– in case of a threat of expansion of infectious diseases, mass poisoning and infection;
– on the request of the authorities of the investigation and investigation, the prosecutor and the court at the link with the conducted investigation or the judicial review;
- for the request of the military commissariats or the military medical service;
– at the time of the occasion to help the incomplete age up to 18 years for informing the father of the lawful representatives;
– for obviousness, it’s possible to vvazhat that Skoda’s health is a huge man of the zapodiya in the wake of the wrongdoing.
For the writing of a hulk or yogo legal representative, it is allowed to transfer information to establish a medical secret, to other hulks, including those who are imprisoned, to punish that patient’s pleasure, for scientific research, publications in the sciences new literature, reference to these records in the initial process for other purposes.

VIII. Sanitary-protiepidemic (preventive) come in with VIL-infection

Prevention of VIL-infection can be carried out in a complex manner according to the virus, mechanisms, pathways and factors of transmission, as well as to the accommodating population, including individuals from different groups of the population.
8.1. Come in the epidemiological centers of VIL-infection
8.1.1. Come in soon dzherela VIL-іnfektsії
When the detected dzherel VIL-іnfektsії zastosovuetsya come in, to reduce the possibility of transmission to the virus:
8.1.1.1. In due course, that diagnosis of VIL-infection was established.
8.1.1.2. Specific therapy with antiretroviral drugs for the indication of a doctor (including prophylactic chemotherapy in vaginal patients) reduces viral exposure in HIV-infected patients and reduces the risk of transmission of HIV infection.
8.1.1.3. Directly on obstezhennya that likuvannya ІPSSH іnfіkovanny VІL zamenshuє rizik transferі statevym slyakhom.
8.1.1.4. Directly slowing down injectable drugs on the drug addiction decreases the activity of the virus transmission risk in the case of vicarious drugs.
8.1.1.5. Fence on the road and deportation of VIL-infected foreign citizens in accordance with the procedure established by the legislation of the Russian Federation, soon a few cases of infection on the territory of the country.
8.1.2. Come in at random mechanisms, ways and factors of transmission
8.1.2.1. Carrying out disinfection and sterilization of medical instruments and possession at medical mortgages, as well as possession of those instruments at perucares, beauty salons, salons that fix piercing and tattooing, and the installation of disposable instruments.
8.1.2.2. Safety and control over the safety of the practices of medical manipulations and the use of barter methods of defense.
8.1.2.3. Examination of blood donors and any other donor materials for the presence of antibodies to VIL during skin donation of donor material, quarantine of blood preparations and vibrating of infected donor material. Dovіchne usunennya VIL-іnfіkovannyh and positive in IFA in the reference-dated blood donation, plasma, organs and tissues.
8.1.2.4. An epidemiological investigation was carried out at the first hour of VIL-infection.
8.1.2.5. Counseling / training of the population – like a friendly contingent, so zherel infection – safe or less unsafe behavior.
8.1.2.6. Preventive work by stern groups of the population (СІН, KSR, ChSCh and іn.).
8.1.2.7. Concerning the contact of the child with the biological mothers of the mother, it may be possible for the indications of ARV drugs to be available:
– pіd h pologіv pіd h of scheduled caesarean section in VIL-infected women;
– after a gently sloping way to replace a child’s breastfeeding for a VIL-іnfіkovan matir on a piece.
8.1.2.8. For the care of the infected VIL women, you can be given additional help in the prevention of non-care vagity.

8.1.3. Come in for a friendly contingent
8.1.3.1. Contact persons in VIL-іnfektsії vvazhayutsya individuals, as they may be able to іnfіkuvati zvіdjachi z vіdomih mekhanіzmіv, shlyakhіv і fаktorіv іntransferіzі zbudnik іnfektsiі. The establishment of the maximum number of osіb, yakі small contacts with VIL-infection, allows you to inform about the method of detecting HIV infection in the course of pre-test counseling and exposure to VIL-infection.
8.1.3.2. Initiation of a safe behavior in the plan of infection with VIL-infection is the main approach in the prevention of VIL-infection among contact persons and population.
8.1.3.3. Carrying out preventive chemoprophylaxis. For urgent prevention of illness to individuals who have recognized the risk of infection with HIV infection, prescribe antiretroviral drugs, including: newborn HIV-infected mothers, medical practitioners and other persons, who suffered during the giving of assistance to VI L-іnfіkovanim to persons, hulks to any є contact, scho having caused a risk of infection with VIL.
8.2. Prevention of intravenous infection VIL
8.2.1. The basis for the prevention of internal infection with VIL-infection and the pre-trial proteepidemic regimen in the liquor-prophylactic settings is viable until the restoration of the disease (SANPIN 2.1.3.2630-10 "Sanitary-epidemiology chnі help to organizations, scho zdіysnyuyut medical activity20, registered 9 "0). No. 18094) Preventive come in to be carried out out of position, if the skin patient is identified as a potential for hemocontact infections (hepatitis B, C, VIL and others).
8.2.2. The control and assessment of the anti-epidemic regime in health care facilities will be carried out by bodies that establish the sovereign sanitary and epidemiological outlook.
8.2.2.1. With the method of prevention of internal transmission of HIV infection, it is necessary to ensure:
8.2.2.1.1. Dotrimanny vstanovlenyh vimog before disinfection, pre-sterilization cleaning, sterilization for medical reasons, as well as before the selection, infection, timchasovogo zberigannya and transportation of medical inputs that are settled in the LPZ.
8.2.2.1.2. Equipped with a non-chilly medical-like-technical-tech-tech-tech, we will convince the atravetim medical, Inststrumentari, buzzers of the disinfect, steril-like zachist (Special Odiag, Tycho mittens) to the normative-methodical document. The chances of a one-time stoppage after victoria and the hour of manipulations in patients lead to infection / disease, and they are repeatedly infected.
8.2.2.1.3. In case of suspicion of an internal infection with VIL-infection in health care facilities, a complex of preventive and anti-epidemic approaches is carried out:
8.2.2.1.4. Scheduled sanitary and epidemiological investigations are carried out with the method of identifying the dzherel, factors of transmission, installing a number of contact points, like among the staff, and among the patients, like they were rebuked in equal minds with the risk of possible infection, that real іzatsії to the complex of prophylactic and protiepіdemіchnyh zakhodіv schodo properedzhennya LPO.
8.3. Prevention of occupational infection VIL
The method of prevention of occupational infection with VIL-infection is carried out:
8.3.1. The complex of calls for the prevention of emergency situations at the hour of vikonanny of various kinds of work.
8.3.2 The appearance of the symptoms in case of professional injury injuries, microtraumas by the personnel of healthcare organizations, other organizations, emergency situations due to blood and biological wounds on the skin and mucous membranes.
8.3.3. In the event of an emergency situation at work, a medical practitioner of goiter should not conduct a complex of entry in order to avoid infection with VIL-infection.
8.3.3.1. The duties of a medical practitioner in case of an emergency:
– at times of pores and injections, take off your mittens, wear your hands with sweet water under running water, wash your hands with 70% alcohol, cover the wound with 5% alcohol with iodine;
– in case of contact with blood or other biological roots on the skin of the neck, treat with 70% alcohol, wash with water and sweet and re-treat with 70% alcohol;
– in case of contact with blood and other biological mothers of the patient on the mucous membrane of the eyes, nose and mouth: clean the empty mouth with a large amount of water and rinse with 70% ethyl alcohol , wash the mucous membrane of the nose and clean it with water (do not rub);
– in case of contact with blood and other biological roots of the patient on a dressing gown, clothes: take work clothes and put them in a disinfectant rozchin or bix (tank) for autoclaving;
– The most common use of antiretroviral drugs with the method of post-exposure prophylaxis of HIV infection.
8.3.3.2. It is necessary in a short term after exposure to HIV and viral hepatitis B and C, a person who may have been in contact with him. Examination for VIL of a potential case of VIL-іnfektsії and individuals who were in contact should be carried out by the method of express testing for antibodies to VIL after an emergency situation with obov'zkovymi directions of the test for a standard test vanya on VIL in IFA. Plasma samples (absorbers) of the blood of a person that is potentially infected with a potential gerel, that contact individual, are transferred for collection for 12 months to the center of the SNID of the Russian Federation.
The injured person, as may be potentially infected with a potential infection, needs to be informed about the presence of viral hepatitis, IPSS, flare-ups of the sechostatic sphere, other ailments, and to conduct a consultation on a lesser risky behavior. - Zhіnka, it is necessary to conduct a test for vagіtnіst i z'yasuvati, chi don't fit with the breasts of a child. Due to the presence of clarifying data, post-contact prophylaxis is started negatively, with the appearance of additional information, the scheme is corrected.
8.3.3.3. Conducting post-exposure prophylaxis of HIV infection with antiretroviral drugs:
8.3.3.3.1. The intake of antiretroviral drugs was due to the first two years after the accident, and not later than 72 years.
8.3.3.3.2. The standard regimen for post-exposure prophylaxis of HIV infection is lopinavir/ritonavir + zidovudine/lamivudine. For the availability of these drugs for the cob of chemoprophylaxis, there may be other antiretroviral drugs; it is impossible to justify a complete HAART regimen by taking one or two known drugs. The use of nevirapine and abacavir is only possible due to the availability of other drugs. As the only one of the known drugs, nevirapine, only one dose of the drug was prescribed - 0.2 g (repeated intake of non-acceptable drugs), then, if other drugs are needed, full chemoprophylaxis is prescribed. As chemoprophylaxis is often associated with the use of abacavir, it would be better to follow up on the reaction of hypersensitivity to a new one, or to replace abacavir with another NDPT.

8.3.3.3.3. Registration of an emergency situation should be carried out in accordance with the following rules:

– the spіvrobіtniki of the LPO are guilty of negainoly talking about the skin accident of the kerіvnik pіdrozdіlu, the yogo intercessor or the greater kerіvnik;
- injuries, taken away by medical practitioners, due to injury in the skin LPO and actuated as an unfortunate fall on the symptoms of the folded Act on the unfortunate fall on the symptoms;
– next save Journal of registration of unfortunate fluctuations in the selection;
– it is necessary to carry out an epidrozlіduvannya of the cause of injuries and establish a connection between the cause of injuries and the medical officer of the service shoes;
8.3.3.3.4. All health care providers are responsible for the safety of the mother, if necessary, access to rapid tests for HIV and antiretroviral drugs. The stock of antiretroviral drugs is responsible for saving up in any health care facility for the choice of health care management bodies in the Russian Federation, and even with such a rozrahunkom, so that the provision of that treatment could be organized for 2 years after the accident new situations. In the upgraded health care facility, there may be appointments for fahivets, depending on the need for taking antiretroviral drugs, taking care of access, including night hours and weekdays.
8.4. Prevention of VIL infection during transfusion of donor blood and components, transplantation of organs and tissue in case of piece-meal
8.4.1. Prevention of post-transfusion HIV infection, HIV infection in organ transplantation and tissue transplantation
zaplіdnenya including come in and take care of safety when collecting, harvesting, collecting donor blood and її components, organs and tissues, as well as when using donor materials.
8.4.2. Preparation of donor blood and її components, organs and tissues.
8.4.2.1. Donors of blood, blood components, organs and tissues (including sperm) are allowed to take donor material after producing documents and results of medical obstezhennia, which confirm the possibility of donation and this safety for medical purposes.
8.4.2.2. During the visits to the promotion of plasma donation, a follow-up was made to explain the need for re-exfoliation of the donor 6 months after the donation.
8.4.2.3. The safety of donor blood, components, donor organs and tissues is confirmed by negative results of laboratory examination of blood samples taken from donor material during the skin sampling, for the presence of blood transmissible infections, including B ІL, with the help of immunological and molecular biological methods.
8.4.2.4. Sampling of donor blood for the identification of markers in hemotransmissible infections is carried out within an hour of the procedure for donating blood and blood components directly from the blood system (without damaging the integrity of the system) or a special companion container for samples, which є at the warehouse of the system, at the vacuum-containing (vacuum-forming ) disposable test tubes, which are suitable for stagnant methods of follow-up When collecting organs and tissues (including sperm), blood sampling from donors for the identification of markers of blood transmissible infections is carried out in parallel to the procedure for collecting donor material (for skin and the task of donor material).
8.4.2.5. At the end of the blood test of the donor, one-hour detection of antibodies to VIL-1, 2 and antigen VIL p24 is carried out. The first immunological examination (IFA) is carried out in a single setting. If a positive result is withdrawn from the analysis, the second follow-up (IFA) is repeated with the choice of reagents, which will stop at the first stage. If you want one positive result in case of repeated testing for VIL-marker, the donor material is disposed of, immediately sent for reference follow-up.
8.4.2.6. It is reserved for re-analysis of sirkopositive blood samples to test systems with less sensitivity and specificity, as well as test systems or methods of the lower generation, lower tests were performed in the primary analysis.
8.4.2.7. Molecular and biological studies (PLR, NAT) are carried out additionally until the overall immunological studies (IFA) for markers of hemotransmissive infections are viable until regulatory documentation and may be of additional significance.
8.4.2.8. First, molecular biological studies are carried out at a single station. If the positive result of the analysis is withdrawn, then two more reagents are repeated, as if they were stopped at the first stage. If you want one positive result during repeated testing, the donor blood sample is considered positive, the donor material is disposed of.
8.4.2.9. Initiate health care, which prepares donor blood components, goiter and develop a system of good virobnicheskoy practice, as it guarantees quality, efficiency and safety of blood components, including the use of modern methods for detecting markers VIL-1,2 and viral hepatitis and the fate of sound quality control systems.
8.4.2.10. Donor blood and її components are transferred to medical deposits for transfusions only after repeated (not less than after 6 months) exposing the donor to the presence of markers of BIL-1,2 viruses and other hemotransmissible infections to exclude the possibility of not having event of infection at the hour of seronegative vikna (quarantine) . Quarantine of fresh frozen plasma refers to the term not less than 180 dB from the moment of freezing at a temperature below 25°C. After the termination of the term of quarantine of fresh frozen plasma, it is necessary to re-exfoliate a healthy donor and laboratory follow-up of the donor's blood with the method of preventing the presence of blood transmissible infections.
8.4.2.11. Blood components with a small term of attachment (up to 1 month) can be taken from personnel (repeated) donors and victorious during the period of the term of attachment. It is your responsibility to confirm PLR and other methods of NAT technology. As an object of investigation, in this case, the blood plasma (sirovatka) is vicarious in the form of tiєї and offensive donation.
8.4.2.12. As an additive approach that promotes viral blood safety and its components, without replacing them, it is allowed to stop the methods of inactivation of pathogenic biological agents.
8.4.2.13. Not dependent on the safety or non-human donor blood components and isolated and subject to disposal, which includes infection with disinfectants or heavy use of physical methods of disinfection for help, doses free for these purposes in the established order, as well as the removal of exits that have been settled.
8.4.2.14. Data about blood donors and її components, procedures and operations that are carried out at the stages of preparation, processing, collection of donor blood and її components, as well as about the results of follow-up of donor blood and її components і are recorded on paper (or) electronic wear. Registration data is collected for a period of 30 years and is due to be available for control by regulatory authorities.
8.4.3. When canceling the organization of blood donation, and її components in information about the possibility of infection of the recipient with blood transmissible infections, it is necessary to identify the donor (donors), in view of which the infection could have become nu donor blood or її components taken from the given donor (donors ) ).
8.4.3.1. At the time of retrieval of information about the possibility of infection of the recipient with hemotransmissible infections, an analysis of the previous declines in donations for a period of at least 12 months is carried out, in order to redo the remaining donations, re-analyze the documentation, and the organization, how to change the blood (plasma) processing, assess the need for the preparation of blood products, type of illness, time interval between donation and follow-up of blood and characteristics of the product.
8.4.4. When blood preparations are found to be safe from donor blood, it is likely to be ambushed by negative results of a laboratory examination of blood samples taken from donors who have taken an hour of skin sampling of donor material, for the presence of blood transmissive infections , including VIL, with the use of immunological and molecular biological methods.
8.4.4.1. Dodatkovo during the processing of plasma for the maintenance of blood preparations, it is necessary to carry out the plasma, combined in technological advancement, for the presence of causative agents of hemotransmissible infections.
8.4.4.2. At all stages of the wine-making process, come in at random to sieve the donated blood plasma, included in the cauldron of the zavantazhennya, to go through the harvesting (disposal or transfer to other harvesting) and ready-made medicinal sample.
8.4.4.3. All plasma was rejected at the input control for fractionation and for obov'azkovy utilization.
8.4.5. Carried out transfusion of donor blood and її components, transplantation of organs and tissues and piece filling.
8.4.5.1. Transfusion of donor blood and її components, transplantation of organs and tissues and piece of blood from donors who are not exposed to the presence of causative agents of blood transmissible infections, including VIL, with vicarious immunological and molecular-bio logical methods.
8.4.5.2. The drug, which prescribes hemotransfusion of blood products, is guilty of explaining to the sick and his relatives the potential risk of transmission of viral infections, including VIL during hemotransfusion.
8.4.5.3. All manipulations regarding the introduction of hemotransfusion media and blood preparations should be carried out according to the instructions for stosuvannya and other regulatory documents.
8.4.5.4. The introduction of blood transfusion media and preparations from the blood of a person from one package to more than one patient is taken care of.
8.4.6. In case of transfusion of donor blood, її components, transplantation of donor organs and tissues from an HIV-infected donor, it is necessary to carry out post-exposure chemoprophylaxis of HIV infection with antiretroviral drugs.

8.5. Prevention of vertical transmission of HIV infection
8.5.1. The manifestation of VIL-infection in a vaginal woman is indicated for the prevention of transmission of VIL to the child's mother.
8.5.2. Infection of a child from a VIL-infected mother can be less vaccinating, especially in late terms (after 30 days), less than an hour when breastfeeding.
8.5.3. Іmovіrnіst transmission і VІL іnі motherі іtіnі without carrying out preventive visits to become 20-40%.
8.5.4. The establishment of preventive medical interventions can reduce the risk of infection in a child in the mother up to 1-2% in the early stages of VIL-infection.
8.5.5. The maximum effectiveness of prophylactic approaches, directed at preventing the transmission of VIL-infections in the mother of a child, reaches a decrease in viral exposure in the blood of the mother to an undetermined level (paid hour of pregnancy and low) and harmful contact in a child with biological birthplaces of the mother (on the hour and after vaginal discharge, breast milk).
8.5.6. To reduce the amount of virus in the blood of the vagina, it is necessary to conduct a consultation on the signs and symptoms of antiretroviral drugs.
8.5.7. To prevent the contact of blood and other tissues of the mother and child, it is necessary:
8.5.7.1. Carry out birth with a viral infection in the mother over 1,000 copies of RNA VIL / ml of plasma, or, as it is not known, by way of a planned caesarean birth: after reaching the 38th day of pregnancy, to the cob of labor rainy waters. With natural canopies, the dry period is short up to 4-6 years.
8.5.7.2. Motivate the infected VIL woman for the child's breastfeeding of the newborn and apply to the breasts.
8.5.8. Drug prevention of the transmission of HIV-infection to the mother of the child (chemoprophylaxis) is better for the prescribed antiretroviral drugs in the mother of the child. Antiretroviral drugs (ARVP) are prescribed to women from 26-28 days of pregnancy (as a woman has no indication for the admission of permanent antiretroviral therapy), pid pologіv and children after the population.
8.5.8. 1. Indications before recognition of ARVP in women and children:
- The presence of VIL-infection in vaginal;
- A positive result of testing for antibodies to VIL in the vagina, including those in the express tests;
- epidemiological indications in vaginal (with negative
due to VIL infection and the obvious risk of VIL infection in the remaining 12 days).
8.5.8.2. For the prevention of transmission of HIV to the mother of the child for the duration of pregnancy and low levels of vagility, a regimen of three antiretroviral drugs is prescribed: 2 nucleoside inhibitors of serum transcriptase + 1 non-nucleoside inhibitor of serum transcriptase or 1 boosting ingi protease inhibitor. In the process of chemoprophylaxis with antiretroviral drugs, there is a complex control of the effectiveness and safety of therapy for the standard scheme.
8.5.8.3. Chemoprophylaxis is prescribed to all children of infected VL mothers from the first year of life, and not later than 72 years after the birth, or from the moment of the remaining vigodovuvannya with mother's milk (for the sake of mindfulness of the attack). The choice of the scheme of antiretroviral prophylaxis in children is determined by the frequency of carrying out such chemoprophylaxis in the mother under the hour of pregnancy, the scheme includes 1 or 3 preparations.
8.6. Prevention of VIL-infection in the organizations of on-line service
8.6.1. Prevention of VIL-infections in the organizations of on-the-spot services (perucarian, manicure, pedicure, cosmetology salons, cabinets, etc.), regardless of the influence of the presence and forms of moisture, be safe in the absence of SanPiN 2 .1.2. 2631-10 "Sanitary and epidemiological assistance to the placement, power, possession, imitation of the regime of work and organization of communal and butyl recognition, which provide Perucarian and cosmetic services", registered by the Ministry of Justice of the Russian Federation Federation 06.07.2010, registration number 17
8.6.2. The organization and conduct of the virobnicheskogo control relies on the manager of the organization.
IX. Hygienic improvement of the population
9.1. The hygiene of the population is one of the main methods of prevention of VIL-infection. Zhoden zahіd okremo can not be saved or start an epidemic of VIL-infection in the region. It is to blame for the implementation of a comprehensive, targeted program of prevention, attention and care for different groups of the population.
9.2. Hygiene of the population includes: reporting information about HIV infection to the population, non-specific prevention of HIV infection, the main symptoms of illness, the importance of the timely manifestation of sickness, the need to take them to the dispensary appearance and other visits to obtain information, leaflets, posters, bulletins, carried out by individual work, directed to the formation of behavior, less unsafe cases of infection with VIL.
9.3. The general population may include consideration of all safe and less unsafe behavior in terms of HIV infection: safe sexual behavior, safe parenteral insertion, occupational safety.
9.4. Preventive work among the population is carried out by the organization of the establishment of the Rosspozhivnaglyadu for the subjects of the Russian Federation, the organization of the establishment of health protection, including: centers for the prevention and fight against SNID, narcological dispensaries and narcological rehabilitation centers, schools rno-venereology clinics, women's consultations and perinatal centers for medical prevention, medical centers, roboticists, disorders and other organizations under the methodical care of the SNID center.
9.5. LPO, independent of the supervision of the order, the fault of the mother, accessible to ailments and medical institutions, on the basis of public awareness of the possibility of infection with HIV, the prevention of drugs, information about the activity of medical institutions of the community zatsіy, yakі give help to infected people, yakі vzhivayut psychoactive speech, persons, scho to give sexual services for a fee, victims of violence and telephone numbers to trust.
9.6. Primary programs of educational mortgages (municipal educational mortgages, other primary mortgages, secondary special primary mortgages, mortgages of primary vocational training, vocational schools) are responsible for food prevention IL-infections.
9.7. It is necessary to ensure the implementation of preventive programs from VIL-infection in the workplace.
9.8. It is necessary to ensure the implementation of preventive programs for HIV infection in the middle groups of the population with a high risk of HIV infection (prevention of injectable drugs, people who may have sexual contacts with people, practitioners of commercial sex).

Name the document:
Document Number:	149-r
Document type:
Accepting body:
Status:	Non-diagnostic
Published:
Acceptance date:	27 April 2000
Date on the cob dії:	27 April 2000
Completion date dії:	December 12, 2011

About come and try harder to fight against the expansion of VIL-infection near St. Petersburg

Administration of St. Petersburg
HEALTH COMMITTEE

CENTER FOR STATE SUPERVISION IN SAINT PETERSBURG

RELEASE

About come in and fight for the expansion
ВІL-іnfektsії near St. Petersburg

Wasted chivalry on a stand
order to the Committee for the Protection of Health of St. Petersburg
dated December 12, 2011 No. 661-r
____________________________________________________________________

The situation with VIL / SNIDu in St. Petersburg has deteriorated sharply since the past year. In 1999, VIL-infection was detected in 440 cases, which may exceed the date of 1998 by 5 times. Increasingly sickness is linked to the epidemic process of injectable drug addicts, often making up 80% of the sum of all innovations in 1999. The highest rate of increase in the incidence of illness in middle age and young people from 16 to 20 years of age. High swidkіst widening VIL-іnfektsії may іє mіsce іn the age group 21-30 roіv. However, the correct number of infections is dozens of times greater than the registered number. According to the St. Petersburg Institute of Epidemiology and Microbiology named after Pasteur, the prevalence of the virus among drug addicts will be 12%, tobto. skin of the 8th of them was infected with the human immunodeficiency virus (according to experts, there are 70-120 thousand injecting drug addicts in the region).

With the help of a stronger approach to fight against the expansion of VIL / SNIDu in St. Petersburg:

1. To the doctors of the district health care management bodies, the head doctors of the health care foundations, the Moscow blood transfusion station, the Moscow medical aid station:

1.1. Organize regional conferences by physicians of various profiles for clinical nutrition, diagnosis, prevention of parenteral and occupational HIV infections.

1.2. To ensure the conduction of seminars by physicians and mid-level medical practitioners with the problems of VIL-infection at the skin liquor deposit.

1.3. Send doctors of a global profile to the cycles of advanced qualifications for the problem of VIL-infection at the Department of Infectious Diseases of the MAPO.

1.4. Vimagati, among medical practitioners, conducted a pre-test consultation with a skin patient about VIL / SNID during blood sampling for follow-up to SNID (addition No. 1).

1.5. The goiter of medical practitioners should seriously fill in all graphs directly on the examination of blood samples in the IFA on VIL (addition No. 2).

1.6. Ensure a thorough medical review of blood donors to prevent drug abusers from giving blood. Do not allow to donation osіb, zvіlnenih іz mіsts uaznennya protyazh remaining 5 rokіv.

1.7. Strengthen control over the safety of donor blood safety, get used to visiting as soon as possible transfusions of whole blood.

1.8. Ensure the care of the dermal work room in order to maintain a sanitary and proteepidemic regime, which will incapacitate parenteral infection of patients and staff.

1.9. Secure the complex of the first anti-epidemic visits at the mercantile mortgages at the time of registration with them VIL-infections.

1.10. Goiter in the field of specialty conduct a look at the VIL-infection of medical practitioners in singing specialties (addition No. 3).

1.11. Goiter

1.11.1. Carry out the form of injuries in medical practitioners, like vinicles for an hour of medical manipulations, and induce accidents for an hour of work with blood from other biological mothers (addition No. 4).

1.11.2. Refer medical practitioners (clause 1.11) to the Center for Prevention and Combating AIDS; at weeks and holy days - until the Moscow infectious diseases clinic N 30 for dispensary care and recognition of emergency chemoprophylaxis.

1.12. Somіsyachno inform the population about the camp of illness on VIL / SNID near the city and preventive visits.

2. Head specialists of the Committee for the Protection of Health will be discussed in the II quarter of 2000. the situation with VIL / SNID near St. Petersburg, with the help of a measure and living in for a pre-test consultation.

3. To the head of the Moscow pathological and anatomical bureau, Kovalsky G.V., to the head of the bureau of the shipboard medical examination, Andriev V.V., the head physicians of the liquor-preventive establishments, to take care of:

3.1. Conducting conferences on the nutrition of pathomorphological changes during the VIL-infection and organization of anti-epidemic visits in case of suspected death due to VIL-infection.

4. To the head physician of the Moscow Center for Prevention and Combating AIDS, Bogoyavlensky G.V.:

4.1. Give judicious and preventive guidelines a lot of information about the situation with VIL-infection in the city, including groups of risky behavior (drug addicts, homosexuals and others).

4.2. Ensure the issuance of informational and illuminating materials, directed at the prevention of the expansion of VIL-infection, for special needs, as if they were trying to free the will.

4.3. To transfer to the head doctor (chief medical officer) of the preventive and curative measures information about the manifestation of VIL-infection with the method of organizing the first anti-epidemic visits. When transferring information, confidentiality must be respected.

4.4. To provide the Center for State Sanitary and Epidemiological Monitoring in the city of St. Petersburg with operational reports on VIL-infections and information about all flu-like conditions, the transition of VIL-infections to the stage of CVID and lethal us lidkiv.

4.5. Carry out a dispensary for the indication of urgent prevention of IVL-infection for medical practitioners in case of injury from them for an hour of service for VIL-infection (addition No. 5).

5. Head physician of the Moscow Infectious Diseases Clinic N 30 named after S.P. Botkin Yakovlev A.A. organize consultations at weekends and holy days of medical practitioners, as they took away injuries from the hour of service to VIL-infected. In case of risk of parenteral infection, urgent chemoprophylaxis should be considered.

6. Head Infectionist Committee for Health Protection Rakhmanova A.G.:

6.1. To prepare until 1 January 2000 a 6-year program to improve the qualifications of doctors and middle medical practitioners in the field of prevention and treatment of VIL-infection problems.

6.2. Take part in the conducted district conferences with a clinical analysis of specific trends.

7. To the head narcologist of the Committee for the protection of health Shpilene L.S.:

7.1. Carry out jointly with the Moscow Center for Prevention and Combating with SNIDom educational work and informational work for the prevention of drug addiction and SNIDu among the middle class, their fathers, young people and the rest of the population.

7.2. Give support to the robots of the unsettled organizations to implement programs to reduce the number of children in the form of internal drug use and the safe state behavior of the environment of drug abusers.

8. Director of the Center for Medical Prevention Volodimirova G.O. conduct informational and educational work with VIL-infections with different groups of the population, including graduates, school teachers, vocational school teachers and medical practitioners, vicorist various forms and methods of education.

9. To the head physicians of the centers of derzhsanepidnaglyadu in the areas of safety:

9.1. Discussed in the II quarter of 2000 at the meetings of the district supra-national sanitary and protidemic commissions about the camp of infection with VIL-infection and the effectiveness of entering, directing to the її ahead of time.

9.2. Introducing additional amendments to district programs on how to fight HIV / SNID with the improvement of the specific epidemic situation, giving special attention to the advancement of the spread of infection in the midst of drug addicts and the fight against drugs mania.

9.3. Received information from especially unsafe infections to the Center for Health and Epidemiological Monitoring near St. Petersburg about the incidence of VIL-infections, revealed in the local area.

9.4. Epidemiological investigation in likuvalno-prophylactic mortgages to the area of ​​skin type VIL-infection. The results of the obstezhennya add to the attention of especially unsafe infections to the Center for State Sanitary and Epidemiological Monitoring in St. Petersburg (addition No. 6).

9.5. Conducted an analysis of the duration of the treatment and preventive measures in the district with VIL-infections, it is necessary to expand the table and submit the results of the analysis 2 times per river (up to 10 pm and 10 days) to the center of derzhsanep at a glance in St. Petersburg.

9.6. Participation in the regional conferences held with VIL-іnfektsії with doctors of various profiles, as well as in seminars at likuvalno-prophylactic mortgages and receptions.

9.7. Violent control over the totality and obstruction of the obstezhennia on VIL-infection and viconnance could help the sanitary and proteepidemic regime in the local preventive measures.

9.8. Control over the conduct of pre-test consultations for blood sampling for the presence of antibodies to VIL and information and educational work with the population.

10. Caregivers established various forms of moisture, private businesses, to give medical services (including cosmetic and health services), to ensure non-severe visits, directing them to the prevention of VIL / SNIDu.

11. Control over vikonannyam of the order to lay on the first intercessor of the head of the Committee for the Protection of Health Taytsya B.M. that intercessor of the head doctor of the Center for Health and Epidemiological Monitoring near St. Petersburg Kolesnikov G.A.

12. Confirm supplements N 1, 2, 3, 4, 5, 6.

Head of the Committee for Health Protection
Administration of St. Petersburg
A.V. Kagan

Golovny sovereign
sanitary doctor in St. Petersburg
V.I. Kurchanov

Addendum 1 to order. Pre-test consultation

Addendum N 1

APPROVED
orders KZ and CDSEN
dated April 27, 2000 No. 149-р/15

Testing for antibodies to VIL may be available to anyone, whom the state of health is turbulent, or the possibility of infection. Testing should be carried out for individuals, such as:

- vvazhayut, scho narazhayutsya on rizik;

- Mayut venereal disease;

- Vzhivayut internally narcotic drugs, as well as may state their partners, scho vzhivayut drugs internally.

At the same time, the consultant assesses the quality of the one who has become angry, as the building of intelligence and victoriousness of information, the ability to change the risky behavior with the method of self-defense, or the risk of transmitting the infection to other people, building take care of self-control, as well as the ability to take the necessary psychosocial support. For an hour of pre-test counseling, the consultant will take information about any biographical and behavioral features of the person who is involved. Vrakhovuychi іntimny nature of wealthy vіdomosti and sing strimanіst і rozmovі pro statu vіdіnіnі, otrimannya psychosocial anamnіzі vіmagає tact, tolerant and respectful rоznnennya reasons, yakі sponkayut consultant put nіtnіnі dіzhososoї yakostі, аlso zapevnen to maintain confidentiality. Anamnestic reports may be filed with reports to realistically assess the risk of infection with VIL, which is known. Vіdpovіdі of that, hto zvernuvsya, let's name it directly and zmіst podshy consultative process. So, for example, stating emotionally significant circumstances for a given individual (love for children and members of the family, religion, exercising professional excellence) gives the possibility of spiracy and motives for a positive result. . Guessing the consultant about the incompleteness of yoga references and significant loved ones allows the singing world to help alleviate the severity of psychoemotional reactions and restore self-control.

The consultant needs to know:

- Why do people want to go through obstezhennya;

- as a behavior, or as symptoms, turbulate the one who has turned into a beast;

- what does it look like to those who have wondered about the test for VIL-infection;

- to inform as much as possible about the ways of transmission of VIL infections, about the risky behavior and methods of prevention.

The consultant evaluates:

- peculiarities of state behavior;

- Frequency of change of state partners;

- Selection of condoms;

- The presence of VIL-infected individual among state partners;

- the behavior is risky (internal treatment of psychoactive diseases, the presence of among the partners of the state, if they are engaged in commercial sex, and also by people, if they may have sexual intercourse with people);

- blood transfusions, blood product victories, organ transplantation;

- non-sterile invasive procedures (invasion, tattooing, incisions).

Consultant z'yasovuє:

- what does the one who thinks about her reaction to a positive or negative test result think;

- who supports the one who tested positive for the test result.

It is the consultant's responsibility to clarify and discuss all the inaccurate statements about the test planning and reconsider what is reasonable, which means a positive result.

The consultant explains that the test only reveals the presence of antibodies to human immunodeficiency virus. The presence of antibodies to VIL is a proof of the presence of VIL-infection, but does not allow us to judge about other, related to VIL-infection of the disease, neither in the present, nor in the future. The consultant is blatant that:

- no test, what a moment to signify, є chi to grow up in people SNID;

- on the basis of a positive test result, it is impossible to say if there was an infection;

- Infection with VIL neobov'yazkovo to report about the innocence of the current partner, tk. could mother place and on the cob їх vzaєmovіdnosin. It is also necessary to clarify the presence of the period of the winter (an hour between infected with VIL and the appearance of antibodies to VIL, the presence of which can be determined by the laboratory method). For a long period of time, the person has already been infected, but with extended blood, antibodies to VIL are not detected.

It is the consultant's responsibility to explain what work is required to prevent transmission of HIV infection during this period (3-6 months). Depending on the results of the test, a decision should be made about the behavior in order to remain uninfected, or to protect other types of infection.

The consultant is guilty of lying, that the one who turned back can:

- buti nadto nalyakany i razgubleniy, schob usvіdomiti told by the consultant;

- don’t know why you ask about the intimate life, and don’t want to tell;

- put unrealistic hopes on the test;

- do not show the bazhannya change the behavior.

The head of the pre-test consultation received an informed decision (informed) about the passage of obstruction for antibodies to VIL. I was informed about the weather at the university, but as a result of the pre-test consultation, the one who was born freely and without a primus stove, giving a call about the cold weather, decides to take the test.

Addendum 2 to order. Directly on the examination of blood in the IFA on VIL

Addendum N 2

APPROVED
orders KZ and CDSEN
dated April 27, 2000 No. 149-p/15

Install name
_______________________
_______________________

Straight N
for follow-up of blood tests in IFA for VIL
at ____________________________________________________________

(install name)

	Registry. number	Name, name, according to the father (forever)		Rik people	Home address	Code for contingent	Date of blood collection	Follow up result

Date "_____" _____________ 2000 p.

Contingent code

Citizens of the Russian Federation
Completed in a planned manner:
Donors (blood, biological mothers, organs and tissues)
Medical personnel who work with ailments on VIL-infected or with infectious material
Settled voluntarily:
Ill on drug addiction
Homo and bisexuality
Sickness for illness, which are transmitted by the path
Individuals, yakі perebuvayut at the places of free will
Seek out for clinical indications
Vagitni (donors of placental and abortion blood)
Announcement of the hour of the epidemiological investigation
Foreign hulks

Note:

If the cooling is carried out anonymously, instruct from the code to be set "anonymously".

Butt: pissed off junkie anonymously - code 102 (anonymously)

As for the stoked one, you can immediately bring in a squirt of codes, you can follow up to one of them with the lowest values. Butt: suturing Before. may be ill, which is transmitted by the state path (code 104), or by a drug addict (code 102), next select code 102 as the least;

- if it is not possible to bring a dressed one to the next one from the assigned contingents, then put the code 118.

Addendum 3 to order. Showing to the medical staff

Addendum N 3

APPROVED
orders KZ and CDSEN
dated April 27, 2000 No. 149-р/15

Obov'yazykovy medical examination for the detection of VIL-іnfektsії when entering the work and with periodic medical examinations are given:

Physicians, middle and junior medical staff:

a) centers for prevention and control of SNIDom, specialized services and structural subdivisions for the protection of health, occupied without intermediary obstezhennyam, diagnostics, likuvannyam, services, as well as carried out by a ship-medical expert and others working with persons infected with the immunodeficiency virus direct contact;

b) laboratories (groups of laboratory staff), as a way to excite the population for VIL-infection and the amount of blood and biological materials, the elimination of diseases of the human immunodeficiency virus;

c) specialized hospitals and services, which provide services for drug addicts;

d) take on medical assistance in obstetric hospitals (the frequency of obstetrics is 2 times per day, it is issued by order of the Ministry of Health of the Russian Federation N 345 ​​of 26.11.1997).

In addition, a medical review of VIL for epidemiological indications is performed by specialists from hospitals and outpatient clinics during registration with VIL-infections in case of manifestations during epidemiological investigation of rough disruption of sanitary and emergency situations. Colo osіb, yakі pіdlyagayut obstezhennya, terms and multiplicity of obstezhennya are determined by the hour of the epidemiological investigation.

Addendum 4 to order. Journal of the appearance of emergency situations, injuries to medical personnel

Addendum N 4

APPROVED
orders KZ and CDSEN
dated April 27, 2000 No. 149-р/15

N vіddіlennya, hospital, profile pіdrozіlu outpatient clinic	A nickname, im'ya, in the father's way of a medical practitioner, who has taken away the injury	Posada of a medical practitioner	Date (year) of injury (accident)	Nature of injury, accident	Diagnosis of the patient	Conducted anti-epidemic visits: primary treatment of wounds, splitting against hepatitis B, referral of a medical practitioner to the SNID Center for vigilance and emergency prevention, disinfection, etc.)	Other views	Signature head. I was told by the head nurse

Note:

- at the column "Character of injury" indicate - a prick with a needle in mittens, without mittens, with a scalpel (in mittens, without mittens), exposure to blood, liquor, instead of ancestral paths on mucus, on the skin;

- in case of an injury after an hour of service for a VIL-infected ailing medical practitioner, a non-gain (with a stretch of 1 dobi) is sent to the Center for Prevention and Combating with SNIDom, at weekends and svyatkovy days - until the reception of the hospital .S.P.Botkin.

Addendum 5 to order. Prevention of VIL-infection and viral hepatitis B and C in medical practitioners

Addendum N 5

APPROVED
orders KZ and CDSEN
dated April 27, 2000 No. 149-р/15

ВІL-infection and hemocontact (parenteral) viral hepatitis B and C are included in the category of most important chronic infectious diseases, which culminate in the development of a full-blown immunodeficiency syndrome (CHID), and in hepatitis - a cirrhotic stage of the disease. livim development of hepatocellular carcinoma.

Infection of a medical practitioner is most often seen in cases of clouded skin and mucus biological fluids of a sick person (blood, sulfur, liquor, sperm, etc.) count, poshkodzhennya shkіri with dribbling tricks of the brush and іn.) .

Slid to bending, the infection of the hepatitis in I s on the vidmin viba vidbuvatuvatuvatuvatuvati is often more than at the Zvyazkoye Menchu, INFIKOKU, I by the Vosokoye Virus in Ceravity Servic.

The risk of professional infection is most of the time less severe than that of medical practitioners, as it sticks with blood and її components.

We are looking for specialists in hematological, resuscitation, dental, gynecological, surgical and hemodialysis care, treatment rooms, laboratory assistants, as well as individuals who work on harvesting from harvesting blood, components and preparations.

Infection of blood and biological material of a person with SNIDu viruses, hepatitis, cytomegaloviruses, a number of oncogenic viruses, the rules for the prevention of occupational infection are expanding on all cuval-prophylactic lays independently in the profile. These rules are made up to the maximum zabіgannya mozhlivostі zabrudnennya shkіri and mucous membranes.

For the prevention of occupational infection:

- when vikonannі manіpulyatsіy medіchny pracіvnіk mіє buti otjagnіnі іn gown, cap, chіnne vzuttya, go іnto yakmu іn between laboratories, vіddіlenі zaboranyаєєєє;

- mustache manipulations, in some cases, hands can be clogged with blood, grayish chin. biological natives, carry out with mittens. Gum mittens, taken once, are not re-worn through the possibility of muddled hands. During the process, the mittens are treated with 70% alcohol, 3% chloramine, alcohol-based chlorhexidine and in;

- medical practitioners are guilty of dorimuvatisya zakhodіv when vikonannі manіpulyatsіy z razalnymi і thorny іnstrumentа (goals, scalpels, scissors);

- vials, flasks, test tubes with blood or blood, next unique injections, opening a mitten and hands;

- in case of poshkodzhennі skіrnih pokrivіv necessitate negainoly obrobit and take mittens, see the blood from the wound, then under running water, carefully shake hands with sweetness, rub them with 70% alcohol and smear the wound with 5% iodine. If your hands are clogged with blood, then gently soak them with a swab, soak them with 3% chloramine or 70% alcohol, wipe them with warm running water with a nice and dry wipe with an individual towel;

- I drank blood on the mucous eyes, washed it with water or 1% boric acid. In case of contact with the mucous membrane of the nose, apply 1% protargol rosemary; on the mucous membrane of the mouth - rinse with 70% alcohol or 0.05% potassium permanganate or 1% boric acid;

- in case of a threat of blood spraying and sirovatka, ulamkіv kіstok zastosovuvat zasosovuvat zakhistu eyes and disguise: zahisnu mask, eyepieces, shields;

- sorting, mittya, polishing medical instruments, pipettes, laboratory glassware, attaching either devices that stick with blood or gray matter, you need to carry out only with humic mittens after frontal disinfection (infection);

- Med. practitioners, like wounds on their hands, exudative lesions on the skin or weepy dermatitis, for an hour they get sick when they look after patients and contact with objects for watching. If necessary, vikonannya must be covered with fingertips, adhesive plaster;

- Forms directly from the clinical diagnostic laboratory are categorically kept at the blood test tube;

- the surface of working tables, for example, a working day (and if it is contaminated with blood - negatively) is treated with 3% of chloramine and 6% of water peroxide with 0.5% of miyuchy zasobu. Moreover, even though the surface is fermented with blood or gray matter, the procedures are two-fold: negligently and with an interval of 15 minutes;

- zapovnennya oblіkovoї and starry documentation can be conducted on a clean table;

- zaboronyaєtsya accept їzhu, smoke that koristuvatisya cosmetics on work tables;

- it is not recommended to carry out annual parenteral and diagnostic procedures honey. to the staff at quiet appointments, yakі recognized for serving the sick.

For nadіyny zahistu medical practitioners against hepatitis, a 3-fold immunization according to the scheme 0-1-6 is carried out, tobto. 1 and 6 months after the first splitting (vaccine companies "Merck, Sharp & Dome", or "Smith Klein Beach", or "Combiotek").

In quiet situations, if there was a traumatization of the hands and other parts of the body from the encrustation of skins and mucous membranes, honey. A practitioner who has not previously been given an anti-hepatitis B vaccine should be immunized for epidemiological indications as well as 3 times in a short term (for scheme 0-1-2) with revaccination after 12 months in a polyclinic infective likarni N 30 named after S.P. Botkin ( tel.: 277-56-71) or the St. Petersburg Moscow Center for Prevention and Combating SNID (tel.: 251-96-29). Cleavage in these episodes can be carried out as a last resort - not more than 1-2 days after injury. Injuries of medical practitioners are responsible for the treatment of skin liquor-prophylactic mortgage. The victims may be afraid of not less than 6-12 months at the infectious disease doctor. Medical precautions are carried out with obov'azkovy obstezhennya for markers of viral hepatitis B, C and VIL-infections.

The best way to prevent infection of medical personnel with the SNIDu virus is to avoid direct contact with the blood and blood of an infected organism. As a result of the damage to the skin or the mucosal medical practitioner, such contact is still taken, it is necessary to go to post-traumatic prophylaxis (PTP) for the help of such antitropical remedies, such as azidothymidine (retrovir), indinavir (crixivan), epivir (lamivudi m) that deakі іnshі.

The control data established that azidothymidine is effective in post-traumatic VIL-prophylaxis. Azidothymidine reduces the risk of HIV seroconversion by approximately 79% after post-traumatic HIV infection. Prospective studies of azidothymidine ingestion in HIV-infected women and children show that an unmediated prophylactic effect of azidothymidine on prenatal and/or neonatal exposure is seen in 67% of changes in perinatal B IL-transmission, the aftereffect of azidothymidine is less frequently explained by changes in titer. Post-traumatic prophylaxis (PTP) itself reduces retroviral activity. In the middle risk of VIL-infection with suprascale blood penetration in the VIL-patient, it becomes 0.3%. The most high risk of infection is indicated with deep lesions of the skin curves, as if there was a visible influx of blood on the medical instrument. When stuck with an instrument, either near the vein or artery of the patient (for example, with a neck during phlebotomy), or in the body of an ailing person (also, a high titer of VIL). The greater the blood supply, the more tasks, the greater risk. In case of superficial low blood levels, the risk of infection changes and becomes 0.1% and less; So far, there are no data on the effectiveness and toxicity of anti-TB drugs, as well as the risk of VIL-infection in the case of quiet and poorer conditions of the grid. However, in most cases, such injuries do not lead to VIL-infection. Therefore, when PTP is recognized, it should be taken to respect її potency toxicity. As such, it is better to look for recommendations to experts in the field of antiretroviral therapy and VIL-transmission.

It appears that the use of azidotimidine (retrovir) and lamivudine (epivir) increases antiretroviral activity and increases the formation of resistant strains. The addition of a protease (indinavir, saquinavir) is especially indicated in cases of high risk infection. However, the effectiveness of the drug against resistant strains, the addition of protease inhibitors is docillary and in situations of lesser risk.

Prevention of HIV infection in patients with risk of parenteral infection

Reduce the risk of infection *)	Obsyag chemoprophylaxis
Visoka (type 1) With deep prickly (naked) or lacerated (scalpel thin) lesions, which are accompanied by bleeding **)	Strongly recommended: Combined therapy of obov'yazkov for 4 days taking 3 drugs - 2 serum transcriptase inhibitors: azidothymidine 200 mg x 3 times per doba lamivudine 150 mg x 2 times daily and one of the protease inhibitors: Indinavir 800 mg x 3 times a day saquinavir 600 mg x 3 times daily
Pomirna (type 2) In case of mild injuries due to "sprinkling" blood	Prop on: Combined therapy in the same regimen with a different stretch of 4 days serum transcriptase inhibitors
Minimum (type 3) In case of superficial traumatization of skins and mucus or trapping biological ridges on mucus.	Bazhana: Azidothymidine therapy for 4 types of inhibitors of serum transcriptase

*) VIL-status of the patient is guaranteed, with the blood of such a contact:

- in case of traumatization in an asymptomatic patient with a high level of CD4 T-helper cells and low viral infection (number of copies of BIL RNA in 1 ml of blood plasma), type 3 chemotherapy is carried out;

- in case of severe clinical picture of infection, CD4 T-helper levels below 500 and/or high viral infections, type 1 chemoprophylaxis is performed (J. Bartlett. Medical Management of HIV infection, USA, Baltimore, 1998).

**) Even before the contact, the patient did not show positive serology, and there is no data about the negative serological test, the bad express test, the shards of the result will become familiar even for a year. Standard serological tests can be collected within 3 to 7 days, but a negative IFA result may be available for 24-48 years. If a patient may be ill with HIV host syndrome, testing may also include VIL RNA or VIL DNA testing.

Addendum 6 to order. Scheme of alerting to the incidence of VIL-infection in the LPZ of the locality

Addendum N 6

APPROVED
orders KZ and CDSEN
dated April 27, 2000 No. 149-р/15

Name of medical facility, district, addresses

A nickname, im'ya, in the father's way of an epidemiologist, who conducts research

Hospital: the number of patients, including the therapeutic, surgical profile, the presence of advanced risk (resuscitation, intensive care, endoscopic and other)

The first letter of the nickname VIL-іnfіkovogo

Date of appearance in IFA, IB

The reason for the obstruction on VIL (N-code)

V_L-infected to the risky group (drug addict, homosexual, industrial school group)

Terms of rebuking at the hospital, at some departments

Diagnosis

The nature of the date of parenteral insertion (i.v., i.m., operative insertion, blood sampling, invasive procedures, blood transfusion) is poor.

There were emergencies in medical practitioners during the hour of treatment, obstezhennija VIL-infected (pierced, pierced, blood got on the mucus, shkir, accidents on the centrifuge thinly)

P.І.B.

Date of sending yoga to the SNID Center for dispensary care

About come and try harder to fight against the spread of VIL-infections near St. Petersburg

Name the document:	About come and try harder to fight against the spread of VIL-infections near St. Petersburg
Document Number:	149-r
Document type:	Order of the Committee for the Protection of Health of St. Petersburg Order of the Center for Sanitary and Epidemiological Supervision of St. Petersburg
Accepting body:	Committee for Health Protection of St. Petersburg Center for Sanitary and Epidemiological Monitoring of St. Petersburg
Status:	Non-diagnostic
Published:	Document of publications not
Acceptance date:	27 April 2000
Date on the cob dії:	27 April 2000
Completion date dії:	December 12, 2011